Kidney failure is when your kidneys no longer function properly. Pregnant people with kidney failure are at a much higher risk of complications. There is generally an improvement in the outlook for people with a prior kidney transplant.

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Your kidneys perform the vital function of filtering wastes and excess fluid from your body. They also make hormones that are important for blood pressure regulation and red blood cell production.

Kidney failure is when kidney function drops below 15% of its usual function. When this happens, your kidneys can no longer work well enough to keep you healthy. The typical treatment for kidney failure is dialysis or a kidney transplant.

If you have kidney failure, you may wonder how it could affect a pregnancy. In this article, we dive deeper into kidney failure and what it means for pregnancy outcomes. Keep reading to discover more.

Learn more about kidney failure.

After you become pregnant, your body undergoes many changes to help support you and your developing baby. The kidneys are no exception to this.

There is a higher blood flow to the kidneys as well as an increase in glomerular filtration rate (GFR) during pregnancy. GFR is how much blood your kidneys can filter each minute.

During pregnancy, GFR increases by 50%. The increase in the filtration capacity helps quickly clear wastes/toxins from your blood that could potentially harm your developing baby.

Pregnancy can place stress on the kidneys, even in a healthy person. In someone with kidney failure, pregnancy can place further strain on your kidneys and potentially worsen your condition.

If you already have impaired kidney function, your kidneys don’t clear waste from your body. They also may not adapt as well in response to a pregnancy. Reduced kidney function means that waste products like urea may be present at higher levels in your blood.

Kidney disease can also impact hormone production by the kidneys. For example, changes in levels of hormones that regulate blood pressure may put you at risk for high blood pressure during your pregnancy, which can lead to complications.

Some of the potential symptoms of kidney failure include:

Sticking to your treatment plan can help you to manage or avoid some of the symptoms above. The treatment of kidney failure typically involves dialysis or kidney transplant.

The risk of complications is higher if you have kidney failure during pregnancy. Research says that pregnant people have a 2–10 times increased risk of adverse outcomes than people who don’t have kidney failure. These include:

If you have kidney failure and are thinking of becoming pregnant, it’s important that you talk with a healthcare professional about the associated risks. You’ll need increased monitoring and treatment alterations during your pregnancy.

The treatment you’ll receive during your pregnancy can depend on whether or not you’re receiving dialysis or have had a kidney transplant. Let’s explore each of these now.

Dialysis

If you’re pregnant and on dialysis, your treatment will be more intensive during pregnancy. This is to help keep up with the increased demand on your kidneys, clearing waste products before they can cause harm to your developing baby.

In pregnant people with kidney failure, dialysis is longer and more frequent. The aim is to reach at least 36 hours of dialysis per week, which comes out to about five to six dialysis sessions each week.

Certain nutrients, such as folic acid and protein, can be lost through dialysis, particularly intensive dialysis. As such, nutritional counseling is important to ensure adequate nutrition.

Generally speaking, kidney transplants show improvement in the outlook for pregnant people more than receiving dialysis. As such, your doctor may suggest delaying your pregnancy until after you’ve had a kidney transplant.

Kidney transplant

When you’ve had a kidney transplant, doctors recommend you wait a year or more after your transplant before trying to get pregnant. The benefits of this are that you:

  • have a lower risk of organ rejection
  • are less likely to be taking certain immunosuppressive medications that could harm a developing baby
  • have time to optimize your overall health in preparation for pregnancy

Medication management

You need to take special care to manage your medications during your pregnancy. This is because some medications can harm your developing baby.

To reduce risk, your doctor may adjust certain medications before or during your pregnancy to ensure that they’re safe for your developing baby. Two examples of medications that your doctor might adjust are:

  • immunosuppressants, which help prevent your immune system from rejecting a kidney transplant.
  • medications that manage blood pressure during pregnancy and prevent complications like preeclampsia

Kidneys make hormones important to red blood cell production, so anemia is common in people with kidney failure. During pregnancy, you may take an iron supplement or medications to help stimulate red blood cell production.

Overall, pregnancy outcomes are better for people with kidney failure who’ve had a kidney transplant. However, the outcomes for pregnant people receiving dialysis have continued to improve over the years.

One 2018 review notes that live birth rates for individuals on dialysis were 37% in 1980 and improved to 52% after 1990. In more recent studies, live birth rates were 80% or higher.

This outcome may be due to the use of intensive dialysis. For example, according to an old 2014 study, live birth rate and duration of pregnancy significantly show improvement for those receiving a more intensive dialysis regimen.

A 2022 study of pregnancy outcomes in people receiving dialysis suggests a live birth rate of 71.4%. The researchers note that preterm birth was the most common pregnancy complication. Others included:

  • small for gestational age (18.9%)
  • miscarriage (16.9%)
  • preeclampsia (11.9%)
  • high blood pressure (7.7%)

As mentioned earlier, pregnancy outcomes show improvement for those who’ve had a kidney transplant. According to a 2022 review, live birth rates of individuals with kidney transplants range between 72% and 93%.

A 2019 study of individuals with a kidney transplant states that the live birth rate was 72.9%. The most common pregnancy complications were:

  • preterm birth (43.1%)
  • pregnancy-induced high blood pressure (24.1%)
  • preeclampsia (21.5%)
  • miscarriage (15.4%)

How common is kidney failure in people of reproductive age?

Research estimates that about 4–16% of people receiving kidney replacement therapy, including dialysis or kidney transplant, are between ages 18 and 45 years.

Does kidney failure affect fertility?

Having kidney failure reduces your fertility. Due to kidney failure, factors like anemia and hormone changes can keep you from having regular periods. A kidney transplant can partly restore your fertility.

How many stages of chronic kidney disease are there?

There are five stages of chronic kidney disease. The higher the stage, the lesser your kidneys function. Doctors classify kidney failure as stage five kidney disease.

There is an association between having kidney failure during pregnancy and an increased risk of complications. These include but are not limited to preterm birth, preeclampsia, and miscarriage.

People with kidney failure who have had a kidney transplant generally have a better outlook than those having dialysis. However, the outlook for people on dialysis has improved over the years due to the use of intensive dialysis regimens.

The decision to have a pregnancy if you have kidney failure is personal. Before conceiving, it’s important to meet with your doctor and discuss the risks associated with pregnancy and the steps that can help mitigate them.