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Review
. 2024 Jan 11;9(5):1183-1197.
doi: 10.1016/j.ekir.2024.01.015. eCollection 2024 May.

Anemia in Pregnancy With CKD

Margriet F C de Jong  1 , Elizabeta Nemeth  2 , Pien Rawee  1 , Kate Bramham  3 , Michele F Eisenga  1
Affiliations
Review

Anemia in Pregnancy With CKD

Margriet F C de Jong et al. Kidney Int Rep. .

Abstract

Chronic kidney disease (CKD), anemia, and iron deficiency are global health issues affecting individuals in both high-income and low-income countries. In pregnancy, both CKD and iron deficiency anemia increase the risk of adverse maternal and neonatal outcomes, including increased maternal morbidity and mortality, stillbirth, perinatal death, preterm birth, and low birthweight. However, it is unknown to which extent iron deficiency anemia contributes to adverse outcomes in CKD pregnancy. Furthermore, little is known regarding the prevalence, pathophysiology, and treatment of iron deficiency and anemia in pregnant women with CKD. Therefore, there are many unanswered questions regarding optimal management with oral or i.v. iron and recombinant human erythropoietin (rhEPO) in these women. In this review, we present a short overview of the (patho)physiology of anemia in healthy pregnancy and in people living with CKD. We present an evaluation of the literature on iron deficiency, anemia, and nutritional deficits in pregnant women with CKD; and we evaluate current knowledge gaps. Finally, we propose research priorities regarding anemia in pregnant women with CKD.

Keywords: CKD; anemia; hepcidin; iron; kidney disease; pregnancy.

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Figures

Figure 1
Figure 1
Course of iron and red blood cell parameters during healthy pregnancy. Reproduced from reference McMullin et al., van Santen et al., and Whittaker et al. with permission.
Figure 2
Figure 2
Simplified pathophysiology of iron deficiency anemia in healthy pregnancy, in CKD, and in pregnant women with CKD. CKD, chronic kidney disease; EPO, erythropoietin; ERFE, erythroferrone; IDA, iron deficiency anemia; RBC, red blood cell. Red color: process that worsens anemia; green color: process that diminishes anemia. Created with Biorender.com.
Figure 3
Figure 3
Proposed flow-chart for work-up and treatment of anemia during Pregnancy in CKD. CKD, chronic kidney disease.
See this image and copyright information in PMC

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