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      Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

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          Abstract

          Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

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          KDIGO clinical practice guideline for the care of kidney transplant recipients.

          (2009)
          The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
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            Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007.

            To examine trends in the incidence and prevalence of rheumatoid arthritis (RA) from 1995 to 2007. To augment our preexisting inception cohort of patients with RA (1955-1994), we assembled a population-based incidence cohort of individuals >or=18 years of age who first fulfilled the American College of Rheumatology 1987 criteria for the classification of RA between January 1, 1995 and December 31, 2007 and a cohort of patients with prevalent RA on January 1, 2005. Incidence and prevalence rates were estimated and were age-and sex-adjusted to the white population in the US in 2000. Trends in incidence rates were examined using Poisson regression methods. The 1995-2007 incidence cohort comprised 466 patients (mean age 55.6 years), 69% of whom were female and 66% of whom were rheumatoid factor positive. The overall age- and sex-adjusted annual RA incidence was 40.9/100,000 population. The age-adjusted incidence in women was 53.1/100,000 population (versus 27.7/100,000 population in men). During the period of time from 1995 to 2007, the incidence of RA increased moderately in women (P = 0.02) but not in men (P = 0.74). The increase was similar among all age groups. The overall age- and sex-adjusted prevalence on January 1, 2005 was 0.72% (95% confidence interval [95% CI] 0.66, 0.77), which is an increase when compared with a prevalence of 0.62% (95% CI 0.55, 0.69) in 1995 (P < 0.001). Applying the prevalence on January 1, 2005 to the US population in 2005 showed that an estimated 1.5 million US adults were affected by RA. This is an increase from the previously reported 1.3 million adults with RA in the US. The incidence of RA in women appears to have increased during the period of time from 1995 to 2007. The reasons for this recent increase are unknown, but environmental factors may play a role. A corresponding increase in the prevalence of RA was also observed.
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              The Global Epidemiology of Diabetes and Kidney Disease

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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                05 November 2018
                November 2018
                : 7
                : 11
                : 415
                Affiliations
                [1 ]Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy
                [2 ]Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France; biancacovella@ 123456gmail.com
                [3 ]Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia; helena.zakharova@ 123456gmail.com
                [4 ]Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia
                [5 ]Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia
                [6 ]Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy; rossella.attini@ 123456gmail.com
                [7 ]Nephrology Service, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico; maribaher@ 123456yahoo.es (M.I.-H.); ggarcia1952@ 123456gmail.com (G.G.-G.)
                [8 ]Instituto Nacional de Perinatologia, Mexico D.F. 01020, Mexico; ale_gaba@ 123456hotmail.com
                [9 ]Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE; mona_539@ 123456yahoo.co.uk
                [10 ]National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China; zhihong--liu@ 123456hotmail.com
                [11 ]Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon; maglo09@ 123456hotmail.com
                [12 ]Nefrologia Ospedale Brotzu, 09100 Cagliari, Italy; gianfranca.cabiddu@ 123456tin.it
                [13 ]Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; philipli@ 123456cuhk.edu.hk
                [14 ]Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; alevin@ 123456providencehealth.bc.ca
                Author notes
                [* ]Correspondence: gbpiccoli@ 123456yahoo.it ; Tel.: +33-669-733-371
                Author information
                https://orcid.org/0000-0002-2632-4009
                https://orcid.org/0000-0003-1145-7404
                https://orcid.org/0000-0003-0558-0035
                Article
                jcm-07-00415
                10.3390/jcm7110415
                6262338
                30400594
                67070c0f-9c0e-47cb-bfcc-832bdf205f2f
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 07 October 2018
                : 31 October 2018
                Categories
                Review

                chronic kidney disease (ckd), dialysis,kidney transplantation,pregnancy,pregnancy complications

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