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Kidney Week

Abstract: TH-PO740

Obstetric Complications in Pregnant Dialysis Patients

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Martin, Kathryn M., Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Waller, Jennifer L., Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Nahman, N. Stanley, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Baer, Stephanie L., Charlie Norwood VA Medical Center, Augusta, Georgia, United States
  • Faiyaz, Seema, ARMC, Aiken, South Carolina, United States
  • Young, Lufei, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Bollag, Wendy B., Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Kheda, Mufaddal, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Gibson, Maya, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Mohammed, Azeem, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
Background

Obstetric complications, including spontaneous abortion (SAB) and pre-term labor (PTL), are more common in dialysis patients than the general population. Information, however, is limited by small numbers of patients studied. To examine these complications and the risk factors for their development in a national cohort, we queried the United States Renal Data System (USRDS).

Methods

Women ages 14 to 50 years starting dialysis between 2004-2011 were included. ICD-9 codes from hospital, physician, or detailed claims identified pregnant patients with SAB or PTL. CMS Form 2728 was used to identify demographics and etiology of ESRD. Generalized linear models were used to estimate the adjusted relative risk (aRR) of each outcome.

Results

There were 1393 pregnancies, with mean maternal age 34±9, 40% white race, and 91% on hemodialysis. ESRD etiologies were: 43% diabetes, 7% hypertension (HTN), 29% SLE, 18% glomerulonephritis (GN), and 3% polycystic kidney disease. The incidence of SAB and PTL was 7% and 10%, respectively. For SAB, there were no differences between ESRD causes. For PTL, the incidence was higher in those with renal failure from HTN, SLE, and GN. The aRR of SAB was higher in non-white, non-black race [2.30] and decreased with increasing maternal age [0.96]. For PTL the aRR increased with pre-eclampsia [1.66], eclampsia [2.00] and intrauterine growth retardation [3.56]. Risk of PTL decreased with increasing maternal age [0.91] and a diagnosis of septicemia [0.58].

Conclusion

SAB and PTL are common obstetric complications in pregnant ESRD patients and greatest in those with ESRD from HTN, SLE, and GN. It is unclear from this work why the risk of complications was decreased in older patients; however we would speculate that younger patients have higher prevalence of SLE, and thus more extensive systemic disease. Similarly, we would suggest that septic patients received more intensive medical therapy and pre-term care, decreasing the risk of complications. Understanding the high-risk groups for complications may improve pre-term care and outcomes.