Professional Documents
Culture Documents
• Fertility improved by :
(Okundye IB,Abrinko P, Hou S, Registry for Pregnancy in dialysis patients, Am J Kidney Dis 1998;31 :766-773)
• Patient with ESKD usually are amenorrhea
due to hormonal imbalance
• Difficulties in determine amenorrhea in
pregnancy
• β-hCG increase in patient with ESKD in the
absent of pregnancy.
• Obstetric ultrasound is favored for
estimation of gestational age in pregnant
women with ESKD
(Hou.S.Grossman S. Onstetric and Gynaecologic issies)
DIALYSIS PRESCRIPTION IN THE PREGNANT
PATIENT
• The improvement in outcome observed in recent
years probably reflect more aggressive
management of woman with ESRD who become
pregnant. These includes :
1) More intensive dialysis schedule with blood urea
nitrogen (BUN) level < 16-18 mmol/L
2) Careful uterine and fetal monitoring during
dialysis includes :
- Fetal Heart Rate
- Maternal Hemodinamic to maintain a good
uteroplacenter circulation
(Bamberg C. Diekmann F, Haase M, et al. Pregnancy and intensified hemodialisis)
• Nocturnal dialysis with a mean dialysis duration :
1. 36 hours preconception
resulted in a mean
gestational age
of 36,2 weeks
and mean
birth weight
2.417,5 ± 657 g.
Canadian American
(Hous S, Pregnancy In chronic Renal Insuficiency and End Stage Renal Disease. 1999)
• Intensive dialysis regiment during
pregnancy can result in
hypophosphatemia
• Most patients often do not require any
phosphate binder, and at times, addition
of phosphorus to dialysate may be
necessary
• There is no experience with savelamer or
lanthanum in pregnancy. There is limitted
data currently on the effect of pregnancy
on dialysis-associated metabolic bone
disease profile
MANAGEMENT OF ANEMIA
• Anemia is common in pregnancy due to volume expansion
• In pregnant patients with ESKD, this physiologic anemia is
exaggregated, and most patients will require erythropoietin and
iron supplementation
• Accentuated anemia and increased erythropoiesis-stimulating
agents (ESA) requirements are attributed to cytokine-induced
erythropoietin resistance and the effect of plasma volume expansion
leading to hemodilution
• ESA is not associated with fetal congenital anomalies at usual dose,
and if patients are on ESA when they become pregnant, the dose is
typically doubled for the length of pregnancy
• Intravenous iron supplementation can be given in pregnant dialysis
patients, given the expected physiologic need for an extra 700 to
1,150 mg of elemental iron during pregnancy
• The US Food And Drug Administration has labelled intravenous iron
is category B for pregnancy
Intravenous iron to
supplement in the extra
700-1,100 mg of elemental
iron needed