{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T01:52:35Z","timestamp":1782525155895,"version":"3.54.5"},"reference-count":44,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:00:00Z","timestamp":1554681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations. Material and methods: CKD women who needed dialysis in pregnancy over the period 2002\u20132014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed. Results: Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg\/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3\u20135 h sessions, with a target urea of &lt;100 mg\/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia. Conclusions: CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes.<\/jats:p>","DOI":"10.3390\/jcm8040475","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T11:54:52Z","timestamp":1554724492000},"page":"475","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country"],"prefix":"10.3390","volume":"8","author":[{"given":"Juan Carlos H","family":"Hern\u00e1ndez Rivera","sequence":"first","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Enfermedades Nefrol\u00f3gicas, CMN Siglo XXI, CdMx 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Juana","family":"P\u00e9rez L\u00f3pez","sequence":"additional","affiliation":[{"name":"Nephrology Service, Hospital de Especialidades CMN \u201cLa Raza\u201d, CdMx 02990, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Humberto","family":"Corzo Berm\u00fadez","sequence":"additional","affiliation":[{"name":"Nephrology Service, Hospital de Especialidades CMN \u201cLa Raza\u201d, CdMx 02990, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3687-5397","authenticated-orcid":false,"given":"Luis","family":"Garc\u00eda Covarrubias","sequence":"additional","affiliation":[{"name":"Transplant Service, Hospital General de Mexico, CdMx 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Antonio","family":"Berm\u00fadez Aceves","sequence":"additional","affiliation":[{"name":"Transplant Service Hospital de Especialidades CMN \u201cSiglo XXI\u201d, CdMx 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrado Alejandro","family":"Chucuan Castillo","sequence":"additional","affiliation":[{"name":"Nephrology Service, Hospital de Especialidades CMN \u201cLa Raza\u201d, CdMx 02990, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Salazar Mendoza","sequence":"additional","affiliation":[{"name":"Emergency Service, Hospital Regional \u201cLic. Adolfo L\u00f3pez Mateos\u201d, ISSSTE, CdMx 01030, M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-4009","authenticated-orcid":false,"given":"Giorgina Barbara","family":"Piccoli","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Le Mans, 72000 Le Mans, France"},{"name":"Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram\u00f3n","family":"Paniagua Sierra","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Enfermedades Nefrol\u00f3gicas, CMN Siglo XXI, CdMx 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s40620-018-0474-6","article-title":"World Kidney Day Steering Committee. 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