A Multinational Cohort Study of Dialysis Initiation During Pregnancy
Bibliographic record
Abstract
Introduction There are insufficient data to guide the initiation of dialysis in pregnancy, contributing to wide variation in practice and uncertainty in the management of this high-risk population. Our study aimed to examine dialysis initiation patterns in pregnancy, describe adverse pregnancy outcomes in women with advanced chronic kidney disease (CKD), and assess the impact of dialysis hours on these outcomes. Methods We conducted a multinational retrospective cohort study of women who delivered between January 1, 2000 and October 31, 2022. Eligible women had either a prepregnancy estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m 2 within 12 months of conception, or a serum creatinine ≥ 150 μmol/l when first measured during pregnancy. For pregnancies where dialysis was initiated, regional differences in dialysis indications, prescriptions, and laboratory data were described. Adverse maternal and fetal outcomes were assessed for all pregnancies. Results A total of 169 pregnancies in 149 women were included; 79 (46.7%) initiated dialysis during pregnancy at a median of 21.4 weeks' gestation (interquartile range [IQR]: 13.3–25.0). There were regional differences in dialysis initiation and dose (hours/wk). Adverse maternal and fetal outcomes were more frequent in women who started dialysis during pregnancy. No significant associations were observed between dialysis hours/wk and adverse maternal and fetal outcomes. At 1 year postpartum, the mean change in eGFR compared with prepregnancy values in nondialyzed women was −8.4 ml/min per 1.73 m 2 (SD: 12.1). Conclusion Advanced CKD poses significant maternal and fetal risks during pregnancy, often necessitating dialysis initiation. Variations in clinical practice underscore the need for standardized care in this high-risk population.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".