Successful pregnancy with nocturnal hemodialysis

A 31-year-old woman with end-stage renal disease was referred to the Toronto General Hospital (Ontario, Canada) for conversion from conventional hemodialysis (CHD; 4 h/session, 3 sessions/wk) to nocturnal hemodialysis (NHD; 7 h/session, 5 to 6 treatments/wk) because of refractory hypertension. As expected, blood pressure control was superior with NHD therapy, and her requirement of vasoactive medications also decreased. To our surprise, 8 months after conversion to NHD therapy, she regained normal menstrual cycles. Two years after NHD therapy initiation, the patient became pregnant, at which time her dialysis prescription was changed to 7.5 h/session, 7 nights/wk. During her pregnancy, blood pressure was well controlled, and biochemical, hematologic, and metabolic parameters were targeted to physiological levels. The patient had an uncomplicated vaginal delivery of a healthy 3,025-g infant at 38 weeks' gestation. This case shows that on NHD therapy, our patient was able to resume ovulation and have an uncomplicated pregnancy. We speculate that augmentation of uremic clearance by means of NHD was pivotal in maintaining a normal nonproblematic pregnancy. Future studies are required to further understand the impact of intensive hemodialysis therapy on reproductive endocrine functions and determine the best management of such patients during pregnancy.