Abstract: FR-PO555

Determinants of Preeclampsia and Low Birth Weight in Pregnant Women with CKD

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Sorohan, Bogdan Marian, Fundeni Clinical Institute, Bucharest, Romania
  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Berbecar, Vlad Teodor, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania, Bucharest, Romania
  • Andronesi, Andreea, Fundeni Clinical Institute, Bucharest, Romania
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
Background

Pregnant women with CKD are at high risk for adverse maternal and fetal outcomes, such as preeclampsia, low birth weight (LBW) and mortality, even those with mild CKD. Moreover, pregnancy itself is a risk factor for CKD progression. CKD and preeclampsia share common features, like proteinuria and hypertension, that make the differential diagnosis difficult during pregnancy. The aim of this study was to evaluate the clinico-biological determinants associated with preeclampsia and LBW in pregnant women with CKD.

Methods

We performed a prospective, observational cohort study on 32 pregnant patients with CKD. Exclusion criteria were eGFR <15ml/min and loss to follow-up. Definitions of preeclampsia in CKD and LBW were defined according to American College of Obstetricians and Gynecologists. To identify the predictors, we performed multivariate Cox and binary logistic regression.

Results

The median age was 23 years (IQR: 21.2-25) and 84.4% were nulliparous. Mean eGFR at referral was 46.5±16.1 mL/min//1.73m2, 78.1% had CKD stage 3-4 and mean 24h proteinuria at referral was 1.01±0.6 g/24h, 50% of patients had >1.5g/24h. The most frequent primary disease for CKD was glomerulonephritis (78.1%), especially lupus nephritis (18.8%). The incidence of preeclampsia and LBW were 56.3% and 53.1%, respectively. Fetal death was present in one pregnancy (3.1%). Patients with preeclampsia were more hypertensive (61.3% vs 35.7%, p=0.15), proteinuric (1.23 vs 0.73 g/24h, p=0.02) and with a more decreased renal function (41.9 vs 52.4 ml/min/1.73m2, p=0.004) at referral. By Cox multivariate analysis proteinuria >1.5g/24h at referral was independently associated with preeclampsia (HR=4.20, CI: 1.47-12.04, p=0.07) and preexisting hypertension presented a suggestive trend of association (HR=2.34, CI: 0.68-6.14, p=0.08). In multivariate logistic regression, proteinuria >1.5g/24h presented a close to significant association with LBW ( OR=3.66, CI: 0.84-15.84, p=0.08).

Conclusion

In conclusion, proteinuria >1.5g/24h at referral is an independent determinant of preeclampsia, also presenting a trend of association with LBW and preexisting hypertension has a marginally significant tendency as a determinant for preeclampsia in pregnant women with CKD.