Pregnancy in Advanced Kidney Disease: Clinical Practice Considerations on a Challenging Combination

Rozemarijn Snoek, Rieke van der Graaf, Jildau R. Meinderts, Franka van Reekum, Kitty W. M. Bloemenkamp, Nine V. A. M. Knoers, Albertien M. van Eerde, A. Titia Lely*

*Bijbehorende auteur voor dit werk

    OnderzoeksoutputAcademicpeer review

    6 Citaten (Scopus)
    43 Downloads (Pure)


    Background:Thanks to the advances in care, pregnancy is now attainable for the majority of young female CKD patients, although it is still a high-risk endeavor. Clinical decision-making in these cases is impacted by a myriad of factors, making (pre)pregnancy counseling a complex process. The complexities, further impacted by limited data and unknown risks regarding outcome, can cause discussions when deciding on the best care for a specific patient. Objectives:In this article, we provide an overview of the considerations and dilemmas we encounter in preconception counseling and offer our perspective on how to deal with them in daily clinical practice. Methods:The main topics we discuss in our counseling are (1) the high risk of pregnancy complications, (2) the risk of permanent CKD deterioration due to pregnancy and subsequent decreased life expectancy, (3) appropriate changes in renal medication, and (4) assisted reproduction, genetic testing, and prenatal or preimplantation genetic diagnostics. Results and Conclusions:In our clinic, we openly address moral dilemmas arising in clinical practice in pregnancy and CKD, both within the physician team and with the patient. We do this by ensuring an interpretive physician-patient interaction and shared decision-making, deliberating in a multidisciplinary setting and, if needed, with input from an expert committee.

    Originele taal-2English
    Pagina's (van-tot)185-189
    Aantal pagina's5
    Nummer van het tijdschrift4
    StatusPublished - apr.-2020

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