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Kidney Week

Abstract: TH-PO733

Racial Disparities and Factors Associated with Pregnancy in ESKD Patients on Dialysis in the United States

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Christianson, Annette, Cincinnati VA, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Pregnancy in women with end-stage kidney disease (ESKD) undergoing dialysis is not common due to impaired fertility. Literature concerning pregnancy in the dialysis population is scarce.

Methods

We evaluated a retrospective cohort of 47,667 women who were aged 15-44 years and were on dialysis between January 1, 2005 and December 31, 2013 from the United States Renal Data System, with primary Medicare claims data, and who carried Medicare as the primary payer throughout 40 weeks of follow-up. We calculated pregnancy rates, and using multivariable proportional intensity recurrent event survival analysis, we identified factors associated with pregnancy including race.

Results

Overall, 2354 pregnancies were identified in 47,667 women on dialysis. The pregnancy rate was 17.7 per thousand person-years (PTPY) (95% confidence interval (CI), 17.0-18.5), and was roughly stable over the nine calendar years. Native American, Hispanic, and black women had higher rates of pregnancy than did Asian or white women (23.2, 22.2, 19.2, 15.6 and 12.8 PTPY, respectively). Women on hemodialysis had a higher rate of pregnancy than did women on peritoneal dialysis (19.3 vs. 9.3 PTPY). In the adjusted survival analysis, a higher likelihood of pregnancy was seen in Hispanic women (HR, 1.65; CI, 1.42-1.91), Black women (HR, 1.47; CI, 1.29-1.66), and Native American women (HR, 1.94; CI, 1.43-2.64) than in white women; in women with ESKD due to malignancy (HR, 1.59; CI, 1.22-2.07), miscellaneous causes (HR, 1.50; CI, 1.25-1.80), glomerulonephritis (HR, 1.47; CI, 1.26-1.70), hypertension (HR, 1.41; CI, 1.22-1.64), and secondary glomerulonephritis/vasculitis (HR, 1.25; CI, 1.06-1.48) than with ESKD due to diabetes; and in women residing in the northeast (HR, 1.29; CI, 1.14-1.47) and midwest (HR, 1.20; CI, 1.06-1.35) than in the south. A lower likelihood of pregnancy was seen among women on peritoneal dialysis than on hemodialysis (HR, 0.45; CI, 0.39-0.53).

Conclusion

Factors associated with a higher likelihood of pregnancy includes race (Hispanic, black, and Native American), ESKD cause (glomerulonephritis, vasculitis, neoplasm, and hypertension), geographical region (northeast and midwest), and hemodialysis modality. This study improves our understanding of pregnancy in patients with ESKD.