Pregnancy and CKD

Question 1

How many hours dialysis are recommended/week?

Answer 1

At least 24/week
HHD 36-48 hours/week improved fetal outcomes

Question 2

What are the protein recommendations for CKD and pregnancy?

Answer 2

CKD3-5: 0.55-0.6 g/kg (+ 10-25 g/day in 2nd and 3rd trimesters
HD/PD: 1-1.2 g/kg (+10-25 g/day in 2nd and 3rd trimesters)

Question 3

What are the kcal recommendations for CKD and pregnancy?

Answer 3

25-35 kcal/kg (+300 kcal/day in 2nd and 3rd trimesters)

Question 4

What are the Na, K, P, and fluid recommendations for CKD and pregnancy?

Answer 4

CKD: limit sodium to 2000-3000 mg/day as needed based on BP and fluid status, liberalize to maintain serum levels WNL
HD/PD: potentially liberalize with more intensive dialysis

Question 5

What are the MVI recommendations for CKD and pregnancy?

Answer 5

CKD 1-3: prenatal
CKD 4-5: renal or prenatal
HD/PD: renal or total daily intake of 2-4 g folic acid

Question 6

What are the vitamin D recommendations for CKD and pregnancy?

Answer 6

CKD: D2 or D3 if deficient
HD/PD: no documented adverse effects documented on fetal outcomes with vitamin D analog use

Question 7

What are the zinc recommendations for CKD and pregnancy?

Answer 7

CKD: 11 mg/day
HD/PD: 15 mg/day

Question 8

What are the calcium recommendations for CKD and pregnancy?

Answer 8

CKD 3-4: 800-1000 mg/day
HD/PD: supplement as needed to maintain serum Ca/P WNL

Question 9

What are the iron recommendations for CKD and pregnancy?

Answer 9

CKD: 30 mg/day
HD/PD: IV may be given as iron sucrose w/o noted complications

Question 10

What are the ESA recommendations for CKD and pregnancy?

Answer 10

Epoetin-a may be given to maintain Hbg WNL; may also give darbopoetin-a.

Question 11

What are the antihypertensive med recommendations for CKD and pregnancy?

Answer 11

Needed if euvolemic but BP >/= 140/90
Labetalol, calcium-channel blockers, and a-methyldopa are acceptable
Avoid ACE inhibitors and ARBs