From the Research
For pregnant women with chronic kidney disease stage 5 (CKD 5) not on dialysis, the target ferritin level should be maintained between 100-500 ng/mL, with an optimal goal of around 200-300 ng/mL. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of balancing iron stores to prevent iron deficiency anemia while avoiding excessive iron supplementation that could increase oxidative stress and inflammation 1.
Key Considerations
- Iron supplementation should be initiated when ferritin levels fall below 100 ng/mL or when transferrin saturation is less than 20% 2.
- Oral iron supplements such as ferrous sulfate 325 mg two to three times daily can be used initially, but intravenous iron (such as iron sucrose 200-300 mg or ferric carboxymaltose) may be necessary if oral therapy is ineffective or poorly tolerated.
- Monitoring should occur monthly during pregnancy due to increased iron demands from both the pregnancy and underlying kidney disease.
Rationale
The management of anemia in CKD patients, including those who are pregnant, is crucial to prevent morbidity and mortality associated with iron deficiency anemia and to minimize the risks associated with excessive iron supplementation 3, 4.
Clinical Implications
Adequate iron stores are crucial for erythropoiesis, especially if erythropoiesis-stimulating agents are being used to manage anemia in these high-risk pregnancies 5. Therefore, maintaining the target ferritin level is essential to ensure the best possible outcomes for both the mother and the fetus.