Making motherhood possible for women with renal disease
Dr. Michelle Hladunewich
At its most recent meeting, Council presented the final 2019 Council Award to Dr. Michelle Hladunewich.
Her work has helped set new worldwide standards for the care of pregnant hemodialysis patients and changed the options for women who previously would have been told to avoid or terminate pregnancies.
Dr. Hladunewich is currently the Physician-in-Chief at Sunnybrook Health Sciences Centre in Toronto. She is also the Medical Lead, glomerulonephritis and specialty clinics, with the Ontario Renal Network, and a professor at the University of Toronto.
At Sunnybrook, she is the founder and lead at Sunnybrook’s Pregnancy and Kidney Disease Clinic (PreKid), the largest specialty renal clinic for high-risk pregnancies in the Ontario, where she has helped hundreds of women living with renal disease have children. The clinic also serves as a training program for medical students and nephrology specialists, many of whom travel from around the globe to learn how to set up similar programs in their communities.
Dr. Hladunewich obtained her medical qualifications at the University of Alberta and the University of Toronto, followed by fellowships in Nephrology and Critical Care at Stanford University.
“Michelle’s dedication to the betterment of patient care places her in a category of excellence that few can match,” said Dr. Rulan Parekh, the Canada Research Chair in Chronic Kidney Disease epidemiology.
We recently spoke to Dr. Hladunewich about her practice:
Q. How did you come to specialize in pregnancy and kidney disorder?
A. When I was at Stanford, I trained in the GN (glomerulonephritis) clinic. I had a great mentor who asked me to assist in his preeclampsia project. It meant that I was often in the obstetrics unit recruiting new patients and the hospital staff started to refer OB patients with kidney issues to me to assess. If it weren’t for that project, I wouldn’t have considered nephrology in the context of women’s health and pregnancy – the two didn’t usually go together. It was a unique approach at the time, as preeclampsia was viewed as a pregnancy complication rather than a kidney disease.
Q. How has the physician-patient conversation about pregnancy and kidney disorder changed over the last 20 years?
A. I would say in the past those conversations were paternalistic. Women with renal disease, especially those on dialysis, who wanted to explore pregnancy were most often told that the risk to their health was too great and pregnancy was not recommended. Now we have the research to show that, with carefully monitored care and management, it is possible to minimize the risk to personal health while pregnant. The big difference in the conversation is the emphasis on the patient’s choice. It is incredibly important that we understand the personal value the patient places on pregnancy. The fact is, many women will sacrifice some kidney function to have a child.
Q. How do you help renal patients understand their options when it comes to their health and pregnancy?
A. It’s important that the conversations be hopeful. The patients who come to the clinic are there because they want to have children and they want our help to make it happen. They want to understand the risks and the possibilities. For my part, I want to make sure the patient and I have a balanced and shared discussion, so that in addition to talking about the risk of pregnancy, I am also hearing what values the patient is bringing to the table. It’s about how and when to have a baby, and figuring out the best and safest way to do it.
Q. What do you see as your proudest professional accomplishment?
A. I’m very proud of the 30 women on dialysis I’ve helped to have babies. And I’m also very proud that my paper on pregnancy and dialysis has made a difference for women who would previously have been told to terminate a pregnancy or to never get pregnant. My research has demonstrated that with careful management and monitoring, it is possible. Now, there is no doubt that it’s a lot of work – for the patient it means dialysis six hours a day for six days and for clinic staff it means constant monitoring and care. But despite the work, it can and has been done. And I know that for many women, the desire to have a child far outweighs the work, the inconvenience and the associated risk to their own health.
Q. What does your role with the Ontario Renal Network involve?
A. I’m the Provincial Medical Lead for Glomerular Disease and Specialty Clinics for ORN. Glomerulonephritis is a group of rare diseases that cause inflammation in parts of the kidney and it disproportionally affects younger people. It’s a complex disease and together with the ORN we are working to improve and change the standard care delivered across the province. We have developed six designated specialist clinics that support every regional renal program in the province. This community has evolved around education and support; for example, we now run monthly provincial glomerulonephritis “rounds” via telemedicine, bringing the province together to understand and improve treatments for the rarest of renal diseases.
Q. Tell us about your family. Can we expect a second generation of physicians in the future?
A. No! There were no doctors in my family growing up – I was the first – and so far, I appear to be the “only.” My two girls are in university now, one is hoping to study law and the other is in neuropsychology and currently applying to PhD programs. I’m incredibly proud of them and grateful for their support and that of my husband, Chris. Without them, I wouldn’t have been able to do what I do.