Pregnancy on short daily home hemodialysis using low flow dialysate. A narrative review of the literature and a new case report

Pregnancy in dialysis patients remains a rare occurrence due to low fertility rates. Furthermore, pregnant women with kidney failure are exposed to a range of fetal-maternal hazards, potentially resulting in severe hypertension, polyhydramnios, intrauterine growth restriction, preterm birth, and stillbirth. However, the incidence of pregnancies in women living with kidney failure has increased over the last decades, and both intensification of dialysis schedule and advances in neonatal care have led to improvement in pregnancy outcomes. Although guidelines for treating pregnant women with kidney failure advocate for intensification of both dialysis frequency and duration, the best and most feasible schedule has not yet been established. Successful pregnancy on daily home hemodialysis using low dialysate flow rate (200 mL/min) by means of small dialysis machines and prepacked dialysate bags (Nx Stage, Physidia S3 systems) was first reported in 2016. We aimed to review the available literature on low dialysate flow rate hemodialysis during pregnancy and report on our experience with a successful pregnancy in a woman who decided to continue home hemodialysis by means of low dialysate flow rate hemodialysis. The literature and our case report underline the importance of considering the patient's modality preferences, and residual kidney function, in the absence of consensus regarding a dialysis intensification strategy.