Anemia in pregnant women with chronic kidney disease

Aim: to determine the incidence and clinical features of anemia in women with chronic kidney disease (CKD) during pregnancy and postpartum period and the effect of anemia on pregnancy outcomes in women with CKD. Methods: 290 pregnant women with CKD 1-5 stages (age 29.4±5.01 years) and disease duration 12.0 [6.0; 20.5] years, observed in 2011-2017, and 19 healthy pregnancies (age 29.54 ± 4.35 years) were included to the study. During pregnancy and in puerperium clinical blood test was taken and serum creatinine, albumin, fibrinogen, C-reactive protein, serum iron, ferritin, soluble transferrin receptors, folates and erythropoietin were studied. Results: anemia was detected in 36.8% of healthy pregnant women, in 36.0% of women with CKD stage 1, in 50.0% of women with CKD 2, 78.7% in women with CKD3A, 83.3% in women with CKD 3B, 85.7% in women with CKD 4, and in 100% of those with CKD stage 5. Severe anemia occurred only in CKD 3-5 with a frequency of 7.4%. The lowest values of hemoglobin level were observed in women with CKD 3-5 in the postpartum period - 86 [77;101.5] g/l. In patients with anemia, the mean hemoglobin content in erythrocyte, levels of transferrin and albumin were significantly lower, and erythrocyte size heterogeneity coefficient and ferritin level were higher. In CKD pregnant women there was no correlation between hemoglobin and erythropoietin levels. A significant positive correlation of hemoglobin level with terms of delivery and the Quetelet index was revealed in all trimesters of pregnancy. Conclusion: anemia is common in CKD pregnant women, develops due to erythropoietin deficiency, in part due to iron deficiency and systemic inflammation, and has adverse effect on pregnancy outcomes.

хроническая болезнь почек, беременность, анемия, гемоглобин, исходы беременности, chronic kidney disease, pregnancy, anemia, hemoglobin, pregnancy outcomes

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