Abstract: TH-PO290
Obstetric Outcomes in Poor CKD Pregnant Women in Mexico
Session Information
- Dialysis: Cost, Socioeconomics, Quality of Life
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 ± 5.8 | 23.8 ± 6.19 | 22.3 ± 4.9 | 0.33 |
| Age < 19 y | 14 (22) | 9 (21) | 5 (25) | 0.75 |
| Education < High-School | 41 (65) | 28 (65) | 13 (65) | 1.0 |
| Known DM | 6 (9.5) | 4 (9.3) | 2 (10) | 1.0 |
| Known HTN | 13 (21) | 8 (19) | 5 (25) | 0.73 |
| 1st Pregnancy | 30 (47.6) | 19 (44.2) | 11 (55) | 0.42 |
| Hgb (g/dL) | 10.71 ± 1.8 | 11.6 ± 1.3 | 8.8 ± 1.4 | 0.001 |
| SCr (mg/dL) | 2.6 ± 2.6 | 1.4 ± 0.6 | 5.2 ± 3.5 | 0.001 |
| eGFR (ml/min/1.73 m2) | 49.7 ± 36.6 | 63.9 ± 44.6 | 18.9 ± 16.1 | 0.001 |
| BMI 25-29.9 | 12 (21) | 7 (19) | 5 (25) | 0.51 |
| BMI ≥ 30 | 4 (7.1) | 3 (16) | 1 (3) | 0.10 |
| Known CKD | 31 (49) | 25 (58) | 6 (30) | 0.03 |
| on RRT | 2 (3.1) | NA | 2 (10) | 0.07 |
| Referral Pregnancy week | 19.1 ± 8.2 | 19.7 ± 8.9 | 17.9 ± 0.6 | 0.42 |
| 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 ± 21.1 | 121.7 ± 23.1 | 122.6 ± 16.6 | 0.87 |
| DBP (mmHg) | 78.1 ± 14.4 | 77.7 ± 14.8 | 78.8 ± 13.9 | 0.79 |
| HD time/week (h) | 14.63 ± 3.6 | NA | ||
| URR | 61.1 ± 7.9 | NA | ||
| Kt/v | 1.1 ± 0.5 | NA | ||
| Preeclampsia | 13 (21) | 10 (23) | 3 (15) | 0.52 |
| C-Section | 48 (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 |
| Prematurity | 29 (49) | 4 (9.5) | 13 (76.5) | 0.008 |
| NICU admission | 21 (38) | 12 (31) | 9 (53) | 0.11 |