Pregnancy in Women With End-Stage Renal Disease: Treatment of Anemia and Premature Labor

Hou, Susan; Orlowski, Janis M.; Pahl, Madeleine V.; Ambrose, Steven; Hussey, Michael J.; Wong, Derek

doi:10.1016/s0272-6386(12)80714-1

Cited by 75 publications

(24 citation statements)

References 19 publications

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“…However, plasma volume increases more than the red cell mass so that a drop in hemoglobin of 1 to 2 grams is normal (13). Dialysis patients are dependent on exogenous erythropoietin for red cell production and hematocrit usually drops sharply (14). (Pregnancy is an unusual cause of "erythropoietin resistance.")…”

Section: Anemiamentioning

confidence: 99%

Modification of Dialysis Regimens for Pregnancy

Hou

2002

Int J Artif Organs

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Section: Anemiamentioning

confidence: 99%

Modification of Dialysis Regimens for Pregnancy

Hou

2002

Int J Artif Organs

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“…rHuEPO has been tested as potential therapy in various maternal disorders during pregnancy. These include: end-stage renal disease [19], antepartum iron deficiency anemia [20], postpartum anemia [9,21], as well as anemia of pregnant women with chronic hematological disorders [13,14], and various more rare clinical conditions [11][12]. These studies showed that rHuEPO administration might be used to treat certain pregnancy anemias by stimulating maternal erythropoiesis or as an alternative for patients refusing blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

“…In a few reported cases of pregnant women with renal failure treated with rHuEPO, hypertension was considered a side effect [19,28]. However, it could rather represent a complication of the underlying renal disease, than a rHuEPO treatment-related adverse effect per se.…”

Section: Discussionmentioning

confidence: 99%

Erythropoietin in the Treatment of Iron Deficiency Anemia during Pregnancy

Sifakis

Angelakis

Vardaki

et al. 2001

Gynecol Obstet Invest

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The aim of this study was to investigate the efficacy of recombinant human erythropoietin (rHuEPO) combined with parenteral iron, in the treatment of moderate and severe iron deficiency anemia during pregnancy. Twenty-six pregnant women, who had been ineffectively treated with iron supplementation alone for at least 8 weeks, were enrolled. They met the following criteria for inclusion in the study: hemoglobin (Hb) concentration <8.5 g/dl, evidence of iron deficiency anemia, and absence of other pregnancy complications, or severe systemic diseases. The treatment protocol comprised of a combination therapy with 150 IU/kg rHuEPO subcutaneously three times per week and 100 mg parenteral iron daily, for a total period of 4 weeks. Nineteen out of 26 women (73%) showed a quick response, with Hb reaching normal levels within the first 2 weeks of treatment. They displayed an average of 3.17 g/dl increase in Hb concentration during the total period of therapy, with 3.0 g/dl increase within the first 2 weeks. In 5 women (19.2%) there was no significant increase in Hb levels, while in 2 women (7.6%) a further decline in Hb concentration was observed, that necessitated a blood transfusion. In conclusion, rHuEPO combined with parenteral iron is an effective treatment for moderate and severe iron deficiency anemia during pregnancy, with minimal adverse or side effects. It may serve as an alternative to blood transfusion, or in cases of resistant anemia that are not effectively treated by iron supplementation alone. However, further studies are needed to investigate the poor response observed in about 25% of treated patients.

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“…Dear Sir, Despite increasingly better methods of renal replacement therapy and excellent he modialysis techniques, pregnancy in chroni cally hemodialyzed patients occurs rather seldom [1,2], Many factors influence the fer tility in dialyzed women, among others re duced libido and sexual function, anemia and endocrinal abnormalities [2][3][4], Preg nancies in patients with end-stage renal fail ure present a great risk for the mother (vol ume overload, exacerbation of hypertension, eclampsia), and for the infant (respiratory distress syndrome, leukopenia, thrombocy topenia, reduced birth weight, adrenocorti cal insufficiency, infection), with the likeli hood of a live birth being, at best. 28-50% [1,2,4,5].…”

mentioning

confidence: 99%

“…Therefore, to minimize these risks, many authors recommended an intensification of the dialysis therapy (to maintain a chemistry that is nearly as normal as possible), the beginning of peritoneal dialysis, rigid control of blood pressure, avoidance of rapid fluc tuations in intravascular volume (interdialytic weight gain has to be limited to about I kg), careful monitoring of the calcium level and minimization of anemia by erythropoie tin [2,3,6,7], Nevertheless, experience with the management of pregnancies in hemodia lyzed women is limited.…”

mentioning

confidence: 99%