Dialysis in Pregnancy: What You Need to Know

Hey. I know why you're here.

You're thinking about having a baby. Or maybe you already are. And youre on dialysis.

Its a big, scary thingtrying to grow a life while your body is working overtime just to keep you going. You might feel overwhelmed. Confused. Even a little hopeless. You might be asking: Can I really do this? Will my baby be okay?

I want you to know something right away: yes, its possible.

Not easy. Not common. But possible. And more womenreal women, just like youare making it through with healthy babies in their arms.

Lets talk honestly about what dialysis in pregnancy really looks like. No sugarcoating. No fear-mongering. Just real talk, backed by research, with a little heart thrown in.

Fertility Realities

Lets start with a tough truth: getting pregnant while on dialysis is rare. Chronic kidney disease often shuts down ovulation, messes with hormones, and can stop periods altogether. A lot of women on dialysis assume pregnancy just wont happen, and in many ways, thats the bodys way of protecting itself.

Butand this is a big butits not impossible.

In fact, some women do conceive. Sometimes its intentional. Often, it happens when contraception wasnt discussed or used. So if youre on dialysis and sexually active, even if you dont think youre fertile, protection matters. But if you are hoping to get pregnant? That dream isnt off the table.

One study found that, despite suppressed fertility, pregnancy does happenand outcomes have improved significantly over the past two decades, especially with aggressive dialysis care.

Dialysis Choices

If youre already a mom-to-be on dialysisor planning to beyou might be wondering: Does the type of dialysis Im on matter?

Short answer: yes. Not all dialysis is created equal when it comes to supporting a pregnancy.

Dialysis Type	Live Birth Rate	Notes
Hemodialysis	Increasing over time	More reported successes, especially with intensive treatment
Peritoneal Dialysis	Lower and static	Abdominal pressure from growing uterus can cause issues

Heres what the data shows: women on hemodialysisespecially those doing longer, more frequent sessionshave better odds of carrying a baby to a more viable gestational age. That doesnt mean peritoneal dialysis cant work, but its trickier as the baby grows. Theres risk of infection, fluid shifts, and mechanical discomfort. In fact, a study published in a PMC journal in 2020 highlighted how PD often requires switching to HD once pregnancy progresses.

So if youre on PD and pregnant? Talk to your team early. This isnt failure. Its smart planning.

When to Start

You might assume dialysis only begins after diagnosis of kidney failure. But in pregnancy? Timing can be everything.

Right now, theres no universal protocol telling doctors exactly when to start dialysis during pregnancy. That means practice variesby hospital, by country, by provider. Its frustrating, I know. But there are guidelines based on real-world evidence.

Doctors look for clear red flags:

• Nausea, vomiting, fatigue (symptoms of uremia)
• Severe acid buildup in the blood
• Persistent high potassium
• Rapid decline in kidney function
• A blood urea nitrogen (BUN) level over 4550 mg/dL before 34 weeks

That last one? Its a big deal. According to expert guidelines (Wiles et al., 2019), that level of BUN is a strong signal that dialysis should startespecially if you're not yet at the stage of full kidney failure.

And heres something that might surprise you: outcomes are much better when dialysis is already underway before pregnancy. Women who start dialysis while already pregnant often face steeper challengeshigher risks of preterm birth, low birth weight, and more intense complications.

If youre thinking about pregnancy, talk to your nephrologist early. Planning ahead? Thats power.

Managing Dialysis

Now, lets get into the heart of it: how dialysis changes when you're pregnant.

If youve seen someone on standard dialysissay, 34 hours, three times a weekyou might wonder: can that support a growing baby?

Honestly? Probably not.

The gold standard for dialysis in pregnancy is whats called intensified hemodialysis. Were talking 6 to 8 hours a day, 5 or 6 days a week. That means nearly full-time treatmentsometimes done at home, sometimes overnight.

Why so much? Because your body has to do triple duty: filter toxins from your blood, support your increased blood volume, and nourish a developing baby. Its like upgrading from a bicycle to a race caryour body needs that extra engine.

And the results? Theyre real. A landmark study by Hladunewich et al. (JASN, 2014) found that women on intensified dialysis had higher birth weights, longer pregnancies, and fewer preterm deliveries.

And theres one number your care team will watch like a hawk: your mid-week pre-dialysis BUN. The goal? Keep it under 3540 mg/dL. Why? Because research shows higher BUN levels directly link to poor outcomessmall babies, early labor, growth delays. Think of it as a fuel gauge: too high, and the system starts to stall.

Risks Involved

Lets not pretend this is easy.

Pregnancy with CKD is high-riskfor you and your baby. I wont sugarcoat it.

For you, risks include:

• Worsening high blood pressure
• Preeclampsia (a dangerous condition unique to pregnancy)
• Fluid overloadyour heart has to work way harder
• Anemia (common in kidney disease, made worse by pregnancy)
• More hospital stays

For your baby? The risks are just as real:

• Preterm birth is the normaverage delivery around 32 weeks
• Low birth weight
• Slower growth in the womb (called IUGR)
• A stay in the NICU is likely
• And yeslonger-term check-ins on their development might be needed

But heres the hope: even with all this, survival rates for babies are rising. A registry study in Italy tracked babies born to dialysis moms and found many grew up healthy, with normal kidney function. According to Piccoli et al. (NDT, 2015), the message isnt doomits cautious optimism.

Building the Team

If youre going to try this journey, you cant go it alone.

This isnt just about nephrology or obstetrics. This takes a village.

Your dream team should include:

• Nephrologist managing your dialysis and kidney health
• Maternal-Fetal Medicine (MFM) specialist the high-risk OB expert
• Neonatologist someone prepping for your babys NICU needs
• Dietitian balancing protein, calories, and nutrients
• Social worker or counselor because emotionally, this is heavy
• Pharmacist to check every medication for safety

Youre not just a patient. Youre the lead voice at the table. Shared decision-makingwhere youre heard, respected, and in controlis non-negotiable. Thats part of being treated with dignity, not just managed like a case file.

And heres what your week might actually look like:

• Dialysis: 68 hours, six days a week
• BUN checks: Every few days, mid-week
• Ultrasounds: Every 46 weeks to track babys growth
• Blood pressure: Monitored at home daily
• Lab tests: For hemoglobin, albumin, electrolytes, nutrition markers

Rigorous? Yes. But its the kind of care that gives you and your baby the best shot.

Medications and BP

Not every medication is safe in pregnancyespecially with kidney disease in the mix.

Blood pressure control is crucial, but its a delicate balance. The target? Under 140/90 mmHg. Going too lowbelow 120/80might reduce blood flow to the placenta, starving the baby of oxygen and nutrients.

Good news: plenty of safe options exist.

Safe in Pregnancy	Avoid in Pregnancy
Labetalol	ACE inhibitors / ARBs
Nifedipine	Direct renin inhibitors
Methyldopa	Most diuretics (except loop)
Hydralazine	NSAIDs

Always double-check every prescription with your team. And remember: dialysis can affect how medications work, so dose adjustments? Very common.

Fuel for Two

Feeding a baby while on dialysis? Thats like trying to refill a bucket with holes in the bottom.

You need more protein1.2 to 1.5 grams per kilogram of body weight per daybecause dialysis removes protein, and your baby needs building blocks. You also need more calories: about 3540 kcal/kg/day.

And supplements? Absolutely.

• Folic acid already in prenatal vitamins, but extra may be needed
• Iron oral often doesnt cut it; IV iron is common
• Vitamin D most kidney patients are deficient
• B-complex lost during dialysis, so replacement is key

This isnt guesswork. Its scienceand its personal. A registered dietitian who specializes in renal nutrition? Thats your secret weapon.

After the Baby

Youve made it through. The babys here. Youre a mom.

But recovery? Its not over.

Your dialysis schedule may ease upyour body doesnt need that same intense support anymore. But watch out for:

• Postpartum blood pressure spikes
• Heart stress (especially if you had fluid issues)
• Blood clotsrisk is higher in chronic kidney disease

Mental health matters too. Postpartum depression is more common in women with chronic illness. If youre feeling numb, overwhelmed, or just not like yourselfplease, speak up. Support is not weakness. Its survival.

What about long-term? Most babies born to dialysis moms do well. And years later, many have normal kidney function. According to Abou-Jaoude et al. (NDT, 2012), these children can grow up completely healthy.

And future pregnancies? Theyre possiblebut talk to your team first. Each journey is different.

Real Hope

Let me leave you with a story.

A woman on nocturnal home hemodialysis8 hours a night, six nights a weekgot pregnant at 29. She worked with her team, kept her BUN under 35 mg/dL, stayed on top of ultrasounds and labs. She delivered at 36 weeks. Her baby weighed over 6 pounds. Healthy. Crying. Real.

It wasnt easy. It was, in her words, "the hardest thing Ive ever done." But shed do it again in a heartbeat.

This isnt just medical data. Its proof: life finds a way. And with the right support, you can, too.

You're Not Alone

Pregnancy on dialysis isnt a journey anyone should walk alone. Its messy, risky, exhaustingand at the same time, full of wild, fierce hope.

Youre not just fighting for your baby. Youre fighting to be a mom.

And if youre asking the hard questions, reading articles like this, reaching out for answers? Thats the start of something brave.

Talk to your doctors. Build your team. Fight for your care. You deserve that chance.

Because behind every search for "dialysis in pregnancy" is a heart saying: I want this. I believe its possible.

And you know what? Youre right.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.