Abstract: PO2599
Does Nephrologist Involvement Improve Aspirin Prescribing in Pregnant Women with CKD?
Session Information
- Women's Health and Kidney Diseases
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Women’s Health and Kidney Diseases
- 2000 Women’s Health and Kidney Diseases
Authors
- Giordano McAuliffe, Christin M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Crants, Shelby Allison, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
- Nguyen, Lynsa, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Zuckerwise, Lisa, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Burgner, Anna Marie, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background
Since 2014, the U.S. Preventative Services Task Force has recommended the use of aspirin beginning at 12 weeks gestation in women at high risk for development of preeclampsia including those with chronic kidney disease (CKD). A prior study at the authors’ institution revealed overall low prescribing rates for women with CKD with only 50.5% taking aspirin according to the recommended guidelines. The authors hypothesized that having a nephrologist involved in patient care would result in higher aspirin prescribing rates.
Methods
The authors reviewed data from pregnancies with delivery between January 1, 2015 and December 31, 2019. Potential pregnancies were identified with diagnostic codes for pregnancies and then included patients who had diagnostic codes for chronic kidney disease and proteinuria. Pregnancies that ended prior to 12 weeks were excluded. Means, standard deviations, medians, and interquartile ranges were used for continuous variables and frequency. Proportions were used for categorical variables.
Results
In total, 91 pregnancies were included. The mean age at due date was 29.7 (std dev 5.3) with 20.9% being of advanced maternal age. The majority were obese (54.9%), with an overall mean BMI of 33.6 (std dev 8.8). During pregnancy, 64.8% (59/91) of patients with known CKD saw a nephrologist. In addition, 20.3% (12/59) of those with known CKD who had previously seen a nephrologist did not see one during pregnancy. Of those who saw a nephrologist during pregnancy, 50.8% (30/59) were prescribed aspirin. In patients who saw a nephrologist at any time before or after pregnancy, 52.1% were prescribed aspirin while of those who did not see nephrologist during pregnancy, 45% were prescribed aspirin. The odds ratio of receiving aspirin if seen by a nephrologist of 2.33 (0.69-7.89) was not statistically significant.
Conclusion
Nearly two-thirds of pregnant women with CKD saw a nephrologist during pregnancy. The involvement of a nephrologist did not significantly increase aspirin prescribing rates among pregnant women with CKD. Further studies should be done to assess attitudes and knowledge of nephrologists and obstetricians to better understand the reasoning for the low prescribing rates and to assess how to improve aspirin prescribing for preeclampsia risk reduction in pregnant women with CKD.