Kidney Week

Abstract: TH-PO1104

Pregnancy Outcome Predictors Among Japanese Patients with CKD

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kumakura, Satoshi, Tohoku University Hospital, Sendai, Japan

Satoshi Kumakura,

• Nakamichi, Takashi, Tohoku University Hospital, Sendai, Japan

Takashi Nakamichi,

• Nagasawa, Tasuku, Tohoku University Hospital, Sendai, Japan

Tasuku Nagasawa,

• Yamamoto, Tae, Tohoku University Hospital, Sendai, Japan

Tae Yamamoto,

• Saito, Masatoshi, Tohoku University Hospital, Sendai, Japan

Masatoshi Saito,

• Miyazaki, Mariko, Tohoku University Hospital, Sendai, Japan

Mariko Miyazaki,

• Sato, Hiroshi, Tohoku University Hospital, Sendai, Japan

Hiroshi Sato,

• Ito, Sadayoshi, Tohoku University Hospital, Sendai, Japan

Sadayoshi Ito,

Background

Studies on pregnant patients with chronic kidney disease (CKD) have been performed worldwide; however, data on the size of the study population, race, as well as information on CKD are limited. On account of limited data rendering the studies non-generalizable, some of the guidelines remain controversial, thereby restricting their application in clinical practice. We conducted a retrospective cohort study to address this problem by clarifying the association between CKD status and pregnancy outcomes.

Methods

Patients with CKD who gave birth or miscarried at our institution between January 1, 2010, and December 31, 2017 were selected as the study population. Clinical data were collected from medical records. We analyzed the correlations between CKD status (age, body mass index, estimated glomerular filtration rate [eGFR], urinary protein-creatinine ratio [UP], mean blood pressure [MBP], and antihypertensive drug use [HTND]) at the time of referral and severe adverse events (SAE). We also focused on the incidence of small-for-gestational-age (SGA) infants and birth weight (BW).

Results

The study included 113 pregnancies among 88 patients. Median age was 32 years (interquartile range [IQR]: 29-36). Median eGFR was 101.8 ml/min/1.73 m² (IQR: 80.9-120.3). Median UP was 0.17 g/gCr (IQR: 0.04-1.1). Of the 88 patients, most were Japanese, 28 had IgA nephropathy, 15 had nephrotic syndrome. SAE in 34 cases included severe pregnancy-induced hypertension, preterm delivery, emergency cesarean section, neonatal intensive care unit admission, low BW, and fetal death. Multivariate logistic regression analysis showed that SAE was correlated with age (odds ratio [OR]=1.14, p=0.025), eGFR (OR=0.98, p=0.013), MBP (OR=1.05, p=0.033), and HTND (OR=4.00, p=0.025). BW was correlated with age (t=-2.20, p=0.03), UP (t=-2.05, p=0.043), and HTND (t=-2.36, p=0.021) according to multivariate linear regression analysis (R-squared =0.20). However, UP alone was a predictor for SGA (OR=1.42, p=0.021) according to multivariate logistic regression analysis.

Conclusion

As in previous reports, eGFR was found to be a predictor of SAE. However, we found that it was UP rather than kidney function that might affect child growth. Therefore, the mechanism of SAE development and the effect on child growth might be different among CKD pregnancies.