A Comparison of Pregnancy Outcomes in Women Receiving Intensive Hemodialysis Versus Kidney Transplant Recipients

Introduction Tailored hemodialysis prescriptions, including more frequent and intensive regimens, may improve pregnancy outcomes, yet most women are counselled to delay conception until after a successful kidney transplantation. Methods We conducted a retrospective cohort study between 2000-2023 in Toronto, Ontario, Canada to compare pregnancy outcomes of women receiving intensified hemodialysis versus kidney transplant recipients. Results We included 48 pregnancies in 37 women receiving hemodialysis and 96 pregnancies in 60 women conceiving post-kidney transplantation. The two patient populations managed by the same multi-disciplinary team had similar live birth rates (80% in hemodialysis and 76% in transplant patients; p-value 0.68). However, the hemodialysis cohort had a shorter pregnancy duration (36.2 weeks; interquartile range (IQR) 32.5-37.1 versus 37.0 weeks; IQR; 35.7-38.0; p-value 0.004) and smaller infants at birth (2202 grams; IQR 1600-2750 versus 2766 grams; IQR 2380-3180; p-value < 0.001). No difference was found in the proportion of pregnancies with reported pregnancy-associated complications (67% in hemodialysis and 73% in transplant; p-value 0.53), including hypertensive disorders of pregnancy at 33% in the hemodialysis cohort and 47% among transplant recipients (p-value 0.18). Conclusion With appropriate counselling and management, pregnancy on hemodialysis may be considered a viable alternative to conceiving post-renal transplant for women without imminent access to a donor.