Pregnancy on haemodialysis in end-stage kidney disease: management within a district general hospital and regional maternal medicine network

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Pregnancy in women with end-stage kidney disease (ESKD) on haemodialysis is rare and carries substantial maternal and fetal risk. Although outcomes continue to improve with advances in multidisciplinary care, optimal management remains challenging and is still evolving. We report two pregnancies managed at a district general hospital within a regional maternal medicine network. In both cases, care centred on intensified haemodialysis six times per week, meticulous fluid management, blood pressure control, anaemia treatment and close fetal surveillance. Both pregnancies resulted in live births at 35 weeks and 34+3 weeks’ gestation, with delivery prompted by fetal growth concerns in one case and severe superimposed pre-eclampsia in the other. These cases show that, with coordinated multidisciplinary care and clear support from a regional maternal medicine centre, selected pregnant people with ESKD can be safely managed on haemodialysis within a district general hospital model when embedded in a regional network.