Pregnancy and early chronic kidney disease

a. We suggest that women with early chronic kidney disease (CKD) who have normal or near-normal renal function (estimated glomerular filtration rate > 60 mL/min/1.73 m 2 ) and who wish to fall pregnant be advised that they can provided their blood pressure is well controlled (2C). b. We recommend that women with CKD who have poorly controlled hypertension or markedly impaired kidney function (estimated glomerular filtration rate < 30 mL/min/1.73 m 2 ) be advised against falling pregnant on the basis of risk of renal functional decline, as well as increased risks of adverse foeto-maternal outcomes, such as pre-eclampsia, eclampsia, pre-term delivery, need for Caesarean section, need for neonatal intensive care, stillbirths and low birth weight babies (1C). c. We recommend that women with CKD receive pre-conception counselling that pregnancy is associated with increased risks of adverse maternal outcomes (gestational hypertension, pre-eclampsia, eclampsia and maternal death) and adverse foetal outcomes (premature births, intra-uterine growth retardation, small-for-gestational age, neonatal mortality, stillbirth and low birth weight) (1C). Note: The degrees of increased risk of each outcome in pregnant women with CKD are difficult to precisely quantitate, although have generally been reported in each study to be at least 2-fold higher than in pregnant women without CKD. d. We recommend that patients with CKD planning to fall pregnant should have their medications reviewed and modified prior to conception. The anticipated benefits of each medication should be weighed against its potential risks. In particular, angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be discontinued. (1D). e. We recommend that pregnant patients with CKD should be carefully monitored for the development of hypertensive disorders of pregnancy and renal functional deterioration, and should also be referred to a nephrologist (1D). f. The above recommendations also apply to women with functioning kidney transplants (1D).