Fertility and Pregnancy Considerations for Patients on Home Hemodialysis

Fertility and pregnancy considerations for patients on home hemodialysis encompass a wide range of important topics. The background and epidemiology of pregnancy in end-stage kidney disease (ESKD) reveal significant improvements in outcomes over recent decades, though risks remain elevated compared to the general population. Understanding the physiological changes of pregnancy and their impact on patients with kidney disease is crucial for proper management. Key considerations include assessment of dry weight, solute clearance, blood pressure control, anemia management, nutrition, and fetal surveillance. The challenges of diagnosing preeclampsia in this population require special attention. Postpartum care involves unique considerations for dialysis patients. Intensive hemodialysis regimens, typically exceeding 36 h per week, have been shown to optimize maternal and fetal outcomes. Managing pregnancy in patients on home hemodialysis requires a multidisciplinary approach and careful monitoring throughout gestation and the postpartum period.