Table 3.

Pregnancy and dialysis monitoring guidelines at the Renal Department of the Royal Brisbane and Women's Hospital.

Guideline	Recommendation/observations/frequency
Dialysis prescription
HD
Dialyser	High-flux, high-efficiency
Duration and frequency	At least 20 h/week
Blood flow rate	300 mL/min
Dialysate flow rate	500 mL/min
Dialysate composition	Calcium 1.75 mmol/L, bicarbonate 25 mmol/L, and glucose 5 mmol/L
Weight review	Weekly clinically + blood volume monitoring weekly
Fluid status	Prefered to leave “wet” as opposed to dry to avoid hypotension
Anticoagulation	Unfractionated heparin (1500 u bolus and 750 u hourly; off for the last 60 minutes)
Erythropoietin therapy	Recommendation to maintain haemoglobin > 110 g/L. May need higher doses
Iron therapy	Intravenous iron to maintain transferrin saturation > 25%
Vital signs	Each dialysis
Blood pressure parameters	Avoidance of hypotension imperative
ensure that phosphate binders and active vitamin D are adjusted as needed
Pathology*	Perform full blood counts, electrolyte, and liver function tests weekly. Vitamin B12 checked every 3 months. Check dialysis adequacy using Kt/V ratio weekly. Other bloods as routinely done in dialysis patients
Haemoglobin	Maintain 110–120 g/L
Iron studies	Aim to achieve a transferrin saturation above 25%
Vitamin B12/folate	Suggest supplement folate 5 mg daily
Magnesium	Keep in normal range
Urea	Aim to keep pre-dialysis < 15 mmol/L
Bicarbonate	Keep in normal range before dialysis
Phosphate	When dialysis hours increased it is important to avoid low phosphate
Urate	Monitor levels
Diet*
High protein	Dietician to review regularly
Supplements	Suggest folate 5 mg daily, vitamin B1 daily, vitamin D 1000 iu daily, and calcitriol (adjust according to phosphate and calcium)
Aspirin	To consider this in consultation with obstetric physicians/obstetricians
Fetal  monitoring*
Ultrasonography	Frequent to monitor growth discussision with obstetricians/obstetric physicians

*Guidelines also apply for peritoneal dialysis.