Live birth in an aboriginal woman receiving chronic haemodialysis
Bibliographic record
Abstract
Background: Chronic Kidney Disease Stage 5 on haemodialysis (CKD G5D) is associated with significant infertility and it disproportionately affects the Aboriginal population. While the Australian and New Zealand Dialysis and Transplant Registry has recorded 7 live births for Aboriginal or Torres Strait Islander women on haemodialysis (HD), no reports documented the intrapartum management of this cohort. Case Report: A 34-year-old, Aboriginal woman (weight 45 kg) with CKD G5D secondary to diabetic nephropathy presented at 9 weeks of gestation. She had a background of type 1 diabetes mellitus, asthma and hypertension and was engaged in multidisciplinary healthcare. Given she had no residual renal function, we increased her HD time from 12 hours/week to 26 hours/week (4 hours on weekdays and 6 hours on Saturdays), aiming for a pre-HD urea ≤ 12.5mmol/L. Her pre-dialysis urea dropped from 22 to 7.8mmol/L within 6 weeks. She was further fluid restricted to 1 litre to manage her interdialytic weight gain. At 27 weeks and 3 days, an emergent lower segment caesarean section was performed for foetal distress secondary to placental insufficiency. A live female baby with intrauterine growth restriction (birth weight 701g) was delivered. Conclusions: This is the first case in Queensland of an Aboriginal woman with CKD G5D delivering a live baby. We propose that using pre-dialysis urea to titrate dialysis duration is a reasonable approach in these challenging patients. Some might postulate gestational age could be lengthened with prolonged dialysis hours >36 hours/week consistent with Canadian centre recommendations. Unfortunately, the practicality of this is often challenging due to compliance and resource availability. More research is needed, particularly in the Aboriginal population who are significantly affected by CKD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".