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Kidney Week

Abstract: TH-PO290

Obstetric Outcomes in Poor CKD Pregnant Women in Mexico

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ibarra-Hernández, Margarita, Hospital Civil de Guadalajara FAA, Guadalajara, Jalisco, Mexico
  • Alcantar Vallin, Maria de la luz, Hospital Civil de Guadalajara FAA, Guadalajara, Jalisco, Mexico
  • Jimenez, Patricia Maria, Hospital Civil de Guadalajara FAA, Guadalajara, Jalisco, Mexico
  • Villagrana, Francisco Villa, Hospital Civil de Guadalajara FAA, Guadalajara, Jalisco, Mexico
  • Diaz-Avila, Jose De jesus, Hospital Civil de Guadalajara FAA, Guadalajara, Jalisco, Mexico
  • Piccoli, Giorgina B., University of Torino, Torino, Italy
  • Garcia-Garcia, Guillermo, Hospital Civil de Guadalajara FAA, Guadalajara, Jalisco, Mexico
Background

CKD affects up to 6% of women of childbearing age. Despite that adverse obstetric outcomes are common in CKD pregnant women, the number of successful preganancies has increased over time, especially in high-income countries. We report outcomes in CKD pregnant women, followed at our integrated Obstetric and Renal Clinic.

Methods

Prospective study in CKD pregnant women followed between June 2013-December 2017. CKD was defined as per KDIGO guidelines. Dialysis was initiated when BUN was ≥ 45 mg/dL or when RRT was clinically indicated. Outcomes were compared between patients who required RRT vs conservative treatment.

Results

Table 1

Conclusion

Poor CKD pregnant women have a high rate of adverse obstetric outcomes. However, an integrated nephrological and obstetric prenatal care throughout all stages of CKD, could lead to successful pregancies, even in resource-constrained settings like ours.

Table 1
 All
n= 63 (%)
Non-HD
n= 43 (%)
HD
n= 20
p
Age (y)23.35 ± 5.823.8 ± 6.1922.3 ± 4.90.33
Age < 19 y14 (22)9 (21)5 (25)0.75
Education < High-School41 (65)28 (65)13 (65)1.0
Known DM6 (9.5)4 (9.3)2 (10)1.0
Known HTN13 (21)8 (19)5 (25)0.73
1st Pregnancy30 (47.6)19 (44.2)11 (55)0.42
Hgb (g/dL)10.71 ± 1.811.6 ± 1.38.8 ± 1.40.001
SCr (mg/dL)2.6 ± 2.61.4 ± 0.65.2 ± 3.50.001
eGFR (ml/min/1.73 m2)49.7 ± 36.663.9 ± 44.618.9 ± 16.10.001
BMI 25-29.912 (21)7 (19)5 (25)0.51
BMI ≥ 304 (7.1)3 (16)1 (3)0.10
Known CKD31 (49)25 (58)6 (30)0.03
on RRT2 (3.1)NA2 (10)0.07
Referral Pregnancy week19.1 ± 8.219.7 ± 8.917.9 ± 0.60.42
CKD Stage
1-2
3
4
5
x
8 (13)
14 (22)
21 (33)
20 (32
x
8 (19)
13 (30)
19 (49)
3 (7)
x
0 (0)
1 (5)
2 (10)
17 (85)
0.001
CKD cause Unkown
GN
DM
CAKUT
Other
33 (55)
11 (18.3)
6 (9.5)
8 (13.3)
3 (5.0)
20 (50)
10 9 (22.5)
4 (9.3)
4 (10)
3 (7.5)
13 (65)
2 (10)
2 (10)
4 (20)
0 (0)
0.68
SBP (mmHg)122.1 ± 21.1121.7 ± 23.1122.6 ± 16.60.87
DBP (mmHg)78.1 ± 14.477.7 ± 14.878.8 ± 13.90.79
HD time/week (h)  14.63 ± 3.6NA
URR  61.1 ± 7.9NA
Kt/v  1.1 ± 0.5NA
Preeclampsia13 (21)10 (23)3 (15)0.52
C-Section48 (77.4)32 (76)16 (80)1.0
Live Birth
Abortion
Stillbirth
56 (92)
2 (3.2)
1 (1.6)
39 (95)
0 (0)
0 (0)
17 (85)
2 (10)
1 (5)
0.17
0.09
0.31
Birth Weight (g)
BW < 2,500
VLBW
2231.86±786.3
30 (52)
9 (15.5)
2281.9 ± 735.7
19 (45)
4 (9.5)
2119.6 ± 406.9
11 (69)
5 (31)
0.47
0.10
0.01
Prematurity29 (49)4 (9.5)13 (76.5)0.008
NICU admission21 (38)12 (31)9 (53)0.11