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      The pregnancy outcomes in patients with stage 3–4 chronic kidney disease and the effects of pregnancy in the long-term kidney function

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          Abstract

          Objective

          To investigate the pregnancy outcomes for patients with stage 3–4 chronic kidney disease (CKD) and the effects of pregnancy on kidney function.

          Methods

          Clinical data of pregnant women with CKD in the Peking University First Hospital between January 1st 2005 and October 1st 2016 were retrospectively analysed. The pregnancy outcomes of patients with different stages of CKD were compared. Patients with stage 3–4 CKD were followed up by telephone interview, and non-pregnant patients with stage 3–4 CKD were selected using the propensity score method to analyse the effects of pregnancy on kidney function.

          Results

          A total of 293 women with 300 pregnancies met the study criteria. There were 30 cases of stage 3–4 CKD. The incidence of adverse pregnancy outcomes of patients with stage 3–4 CKD was significantly higher than that with stage 1 CKD. The mean postpartum follow-up time of pregnant patients with CKD was 49.0 ± 33.1 months. A total of 26 cases of stage 3–4 CKD were followed up. During the follow-up period, 8 patients progressed to ESRD. A total of 28 non-pregnant patients with stage 3–4 CKD were selected as the control group. The results of multivariate analysis revealed that pregnancy did not increase the risk of deterioration of kidney function.

          Conclusion

          Patients with stage 3–4 CKD in early pregnancy had a significantly increased risk of adverse pregnancy outcomes. Pregnancy itself did not seem to accelerate kidney disease progression in patients with stage 3–4 CKD.

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          Risk of Adverse Pregnancy Outcomes in Women with CKD.

          Giorgina Piccoli, Gianfranca Cabiddu, Rossella Attini … (2015)
          CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (>1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P<0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.
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            A Systematic Review and Meta-Analysis of Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy.

            Jing-Jing Zhang, Xin-Xin Ma, Li Hao … (2015)
            We undertook a systematic review and meta-analysis of published cohort studies and case-control studies to estimate (1) the risk of pregnancy complications among patients with CKD versus those without CKD and (2) the risk of CKD progression among pregnant patients versus nonpregnant controls with CKD.
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              Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes.

              Nicholas Giudice, Gianfranca Cabiddu, Gina Gregorini … (2007)
              Prognostic criteria to inform women with moderate to severe renal insufficiency who wish to bear children are not well established. Longitudinal multicenter cohort study. Nondiabetic white women with pregnancies proceeded beyond the 20th week and estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m(2) (<1 mL/s/1.73 m(2)) before conception. Baseline GFR and proteinuria (exposure); other clinical characteristics at conception (covariates). Difference in GFR decreases before conception versus after delivery (mixed linear models); low birth weight (<2,500 g), and maternal renal survival (logistic and Cox regressions). 49 women were studied. Mean serum creatinine and GFR at conception were 2.1 +/- 1 (SD) mg/dL (186 +/- 88 micromol/L) and 35 +/- 12 mL/min/1.73 m(2) (0.58 +/- 0.2 mL/s/1.73 m(2)), respectively. Overall mean GFR after delivery was less than before conception (30 +/- 13.8 versus 35 +/- 12.2 mL/min/1.73 m(2) [0.50 +/- 0.23 versus 0.58 +/- 0.20 mL/s/1.73 m(2)]; P < 0.001), but the rate of GFR decrease did not change (0.55 +/- 0.8 versus 0.50 +/- 0.3 mL/min/mo [0.0092 +/- 0.013 versus 0.0083 +/- 0.005 mL/s/mo]; P = 0.661). Independent of potential confounders, the combined presence of baseline GFR less than 40 mL/min/m(2) (<0.67 mL/s/m(2)) and proteinuria with protein greater than 1 g/d, but not either factor alone, predicted faster GFR loss after delivery compared with before conception (1.17 +/- 1.23 versus 0.55 +/- 0.39 mL/min/mo; difference, 0.62 mL/min/mo; 95% confidence interval [CI], 0.27 to 0.96 mL/min/mo [0.020 +/- 0.021 versus 0.0092 +/- 0.007 mL/s/mo; difference, 0.10 mL/s/mo; 95% CI, 0.005 to 0.016 mL/s/mo]). The presence of both risk factors, but not either alone, also predicted shorter time to dialysis therapy or GFR halving (N = 20; hazard ratio, 5.2; 95% CI, 1.7 to 15.9) and low birth weight (N = 29; odds ratio, 5.1; 95% CI, 1.03 to 25.6). Generalizability to other settings; study power. In women with renal insufficiency, the presence of both GFR less than 40 mL/min/1.73 m(2) (<0.67 mL/s/m(2)) and proteinuria with protein greater than 1 g/d before conception predicts poor maternal and fetal outcomes.
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                Author and article information

                Contributors
                Qian Chen:
                ORCID: http://orcid.org/0000-0003-2508-4311
                0086-10-83573222 , chenqianobs@126.com
                Journal
                Journal ID (nlm-ta): J Nephrol
                Journal ID (iso-abbrev): J. Nephrol
                Title: Journal of Nephrology
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 1121-8428
                ISSN (Electronic): 1724-6059
                Publication date (Electronic): 19 July 2018
                Publication date PMC-release: 19 July 2018
                Publication date (Print): 2018
                Volume: 31
                Issue: 6
                Pages: 953-960
                Affiliations
                [1 ]ISNI 0000 0004 1764 1621, GRID grid.411472.5, Department of Obstetrics and Gynecology, , Peking University, First Hospital, ; Beijing, 100034 People’s Republic of China
                [2 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, Renal Division, Department of Medicine, , Peking University, First Hospital, Peking University Institute of Nephrology, ; Beijing, People’s Republic of China
                Author information
                http://orcid.org/0000-0003-2508-4311
                Article
                Publisher ID: 509
                DOI: 10.1007/s40620-018-0509-z
                PMC ID: 6244551
                PubMed ID: 30027380
                SO-VID: 15491a60-988a-4225-8f8f-6869b6efa03a
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 12 February 2018
                Date accepted : 14 June 2018
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Italian Society of Nephrology 2018

                Keywords: chronic kidney disease,pregnancy,renal disease progression
                Data availability:
                Keywords: chronic kidney disease, pregnancy, renal disease progression

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