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DALLAS -- A third of nephrologists reported being somewhat to very uncomfortable caring for a pregnant patient on hemodialysis despite a growing number having to do so, said researchers here.

A small mailed survey found that 43% of nephrologist respondents have cared for a pregnant patient on dialysis, and in 32% of those pregnancies, dialysis was started during the pregnancy. Half of all the pregnancies were complicated by preeclampsia, and 23% of the reported pregnancies did not result in a live birth, said researchers, led by Mala Sachdeva, MD, at the North Shore-Long Island Jewish (LIJ) Health System in Great Neck, N.Y. She reported her results with her colleagues at a poster session during the spring clinical meeting of the National Kidney Foundation.

"We had actually noticed that we were caring for more and more pregnant patients on dialysis, and we had a couple of successful pregnancies and we wanted to see what the U.S. experience was," said Sachdeva in an interview with MedPage Today.But she said the team was surprised by the outcomes. "They were not great, though there were no reported maternal deaths. It tells us that we need something to work on," she said.

Data were taken from a survey sent out in May 2014 with 23 questions about the experience of pregnant women on dialysis, fetal outcomes, and current clinical patterns associated with pregnant patients on dialysis. Seventy-five nephrologists responded.

More than 59 pregnancies were reported in the last 5 years, and in 32% of the reported pregnancies, dialysis was started during pregnancy. In 58%, the pregnancy occurred within the first 5 years of being on maintenance dialysis.

Half of the nephrologists or a member of their staff had to counsel a female dialysis patient about contraception, the study found. And three-quarters of respondents didn't have access to fetal monitoring during dialysis for the patient.

Most of the nephrologists had their pregnant patients on 4 to 4.5 hours of hemodialysis for 6 days a week, and two-thirds of nephrologists targeted a blood urea nitrogen (BUN) of less than 50mg/dL. But there are no clear guidelines on how to dialyze a pregnant women, said Eileen Miller, MD, medical director of dialysis at North Shore-LIJ to MedPage Today.

The lack of guidelines accounts for a part of why many nephrologists reported being uncomfortable dialyzing a pregnant patient, said Miller. Another reason is that pregnant women on dialysis were relatively uncommon. "But as dialysis has gotten better, we're seeing more of it, and we need better guidelines so people will feel more comfortable. The last studies done looking at pregnant patients were more than 15 years ago," she said.

Miller said she's hopeful that more research will be done in the area.

Sachdeva and co-authors disclosed no relevant relationships with industry.

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