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Pregnancy and Renal Failure

The Case for Application of Dosage Guidelines

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Abstract

Pregnancies in women with renal disease, undergoing dialysis treatment or with kidney transplants are increasingly observed. Serious problems with drug dose adjustment may arise in pregnant women with renal impairment. This review gives a practical overview on the risks of drug use during gestation, the recommended drugs of choice (e.g. methyldopa, cyclosporin), and provides some proposals for dosage adjustments in pregnant women with renal impairment.

In normal pregnancy, the glomerular filtration rate and plasma volume increase, whereas plasma protein binding and liver function may be impaired. An increase in dosage is needed for cyclosporin and for methadone because of increased hepatic clearance. The dosage of erythropoetin must be increased because of lower potency in pregnant women. Little more is known on the impact of gestation on drug dose, since pharmacokinetic studies are rarely done in pregnant women.

The dosages of magnesium, lithium and morphine must be reduced in renal impairment. Dose adjustment to renal function is critical and is essential for anti-infective agents (e.g. ceftazidime, ganciclovir). Basing drug dose on estimated creatinine clearance might be the most practical solution in pregnant women with renal impairment.

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Acknowledgements

Part of this work was supported by the European Commission within the CRAFT project PharmDIS (BMH4-CT98-9548). There is no conflict of interest to disclose.

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Authors and Affiliations

  1. Division of Nephrology, Medical Faculty, University of Ulm, Ulm, Germany

    Frieder Keller, Martin Griesshammer & Ulla Häussler

  2. Teratology Information Service, Kloster Roggenburg, Roggenburg, Germany

    Wolfgang Paulus

  3. Medizinische Hochschule Hannover, Hannover, Germany

    Anke Schwarz

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  1. Frieder Keller
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  2. Martin Griesshammer
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  3. Ulla Häussler
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  4. Wolfgang Paulus
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  5. Anke Schwarz
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Correspondence to Frieder Keller.

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Keller, F., Griesshammer, M., Häussler, U. et al. Pregnancy and Renal Failure. Drugs 61, 1901–1920 (2001). https://doi.org/10.2165/00003495-200161130-00003

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