Phosphorus-enriched hemodialysis during pregnancy: Two case reports.

Successful pregnancy leading to delivery of a viable infant is an uncommon occurrence either in women with established renal disease or in those with renal failure requiring chronic dialytic treatment. The frequency of conception in patients with renal failure has increased, however, and the outcome of such pregnancies has improved over the past 32 years. Current guidelines for dialysis in pregnant women include prolonged dialysis times, generally 20 or more hours per week. This extensive dialysis regimen often results in a decrease in the serum inorganic phosphorus levels, with possible detrimental effects to the health of the mother and the unborn child. In this article, we report the successful multidisciplinary management of two pregnant women with end-stage renal disease, both of whom developed hypophosphatemia after initiation of intensive hemodialysis. Sodium phosphate salts were added to the dialysate of each patient and this addition successfully corrected the decrease in serum inorganic phosphate concentration. One patient was able to carry the pregnancy for 28 weeks with delivery of a healthy 1260-g infant. The pregnancy of the second patient ended at 25 weeks of gestation with delivery of a nonviable infant.