Hypertension and associated complications in pregnant women with chronic kidney disease

Table 3 Summary of recommendations for prevention and management of hypertension in pregnant chronic kidney disease patients

Multidisciplinary treating team involving consultant obstetrician, nephrologist and an expert midwifery team
Prevention strategies	Low dose aspirin to be started before 16 weeks pregnancy with dose > 80 mg/ day
	First trimester screening for pre-eclampsia for all chronic kidney disease patients
	Low-molecular-weight heparin prophylaxis in patients with previous adverse placenta-mediated obstetric outcomes
	Oral elemental calcium 1.5-2 g/day
	Dialysis requiring patients: Frequency of dialysis 5-7 times/week, duration > 20 hours/week, anuric dialysis patients should get high intensity dialysis > 36 hours/week
Management of hypertensive disorders	Regular blood pressure charting at every antenatal visit. Maintain blood pressure target < 135 mmHg/85 mmHg
	Magnesium sulphate can be given for prevention of eclampsia. Magnesium levels should be checked every 6 hours, and maintained less than 3.7 mmoL/L
	Maintain haemoglobin levels of 10-11 g/dL
	Recommended protein intake in dialysis patients is 1.8 g/prepregnancy weight/day + 20 g/day. Calorie requirement is 23–35 kcal/pregnant weight/day
	Immunosuppression levels to be regularly monitored and to ensure adequate immunosuppression
	Careful fluid management throughout pregnancy
	Neuraxial anaesthesia is preferred
	To avoid NSAIDs and nephrotoxic drugs