Pharmacotherapy considerations in pregnant patients on hemodialysis

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-06-21 DOI:10.1111/hdi.13107

Beatrice Drambarean, Justyna Mastalerz, Lisa Wendt, Stephanie Toth-Manikowski

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Abstract

Purpose

Successful pregnancy rates on dialysis are increasing with the advent of intensive hemodialysis and advances in medical management.

Summary

Data support the use of intensive hemodialysis in pregnant women with end-stage kidney disease (ESKD). This paper provides an overview of common pharmacotherapeutic changes in management when caring for a pregnant woman receiving intensive hemodialysis. Pregnant patients on peritoneal dialysis were excluded from this analysis due to insufficient data. Topics covered include those related to anemia (iron and erythropoietin stimulating agents), blood pressure agents, monitoring of phosphorus, as well as nutrition and anticoagulation.

Conclusion

When patients on hemodialysis become pregnant, medication adjustments are needed regarding antihypertensives, anemia management, and mineral-bone disease management as many agents require dose adjustment, switching agents due to teratogenicity, or cessation due to fetal complications. There are minimal data in this population; however, successful and healthy infants have been delivered in this patient population with the medication changes discussed.

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妊娠血液透析患者的药物治疗考虑

目的随着强化血液透析的出现和医学管理的进步，透析成功妊娠率不断提高。数据支持在终末期肾病(ESKD)孕妇中使用强化血液透析。这篇论文提供了一个共同的药物治疗的变化管理的概述，当照顾孕妇接受强化血液透析。由于资料不足，腹膜透析的孕妇被排除在本分析之外。所涵盖的主题包括与贫血(铁和促红细胞生成素刺激剂)、血压剂、磷监测以及营养和抗凝有关的内容。结论当血液透析患者怀孕时，需要调整降压药、贫血治疗和骨矿病治疗的药物，因为许多药物需要调整剂量，由于致畸而切换药物，或由于胎儿并发症而停止使用。这个群体的数据很少;然而，成功和健康的婴儿已经在这些患者群体中分娩，并讨论了药物变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.