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Kidney Week

Abstract: PO2233

Second Trimester eGFR and Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Lucas, Anika, Duke University, Durham, North Carolina, United States
  • Eudy, Amanda, Duke University, Durham, North Carolina, United States
  • Wyatt, Christina M., Duke University, Durham, North Carolina, United States
  • Clowse, Megan, Duke University, Durham, North Carolina, United States
Background

Adverse pregnancy outcomes are more common in women with SLE.2nd trimester eGFR was shown to predict adverse pregnancy outcomes in a general population cohort.We sought to evaluate 2nd trimester eGFR as a predictor of adverse pregnancy outcomes in women with SLE.

Methods

We evaluated 684 women with SLE(22% of Black race)who received care in North America and Europe from 1995-2017.2nd trimester eGFR was stratified based on studies demonstrating women with an eGFR 120-135 ml/min/1.73m2 had the lowest odds of adverse outcomes.Outcomes of interest included preterm birth, preeclampsia,fetal loss and poor pregnancy outcome(composite outcome).2nd trimester GFR was computed using the CKD Epi equation without adjustment for race.In sensitivity analysis, 2nd trimester GFR computed using the conventional race-based equation.Polynomial and logistic regression models used to evaluate 2nd trimester eGFR and adverse outcomes.

Results

Very low eGFR(eGFR<90ml/min/1.73m2)and very high eGFR (>135ml/min/1.73m2)were associated with higher adverse outcomes.In univariate and multivariable regression models adjusted for age,race,and SLE disease activity,very low eGFR was associated with preterm birth,preeclampsia,fetal loss and poor pregnancy outcome.Very high eGFR was associated with poor pregnancy outcome and preterm birth.In sensitivity analyses using race based GFR estimates,very low eGFR remained associated with adverse outcomes observed.No association was observed between very high eGFR and adverse outcomes.

Conclusion

We found a U-shaped relationship between 2nd trimester eGFR and adverse pregnancy outcomes.Women with eGFR <90ml/min/1.73m2 and >135ml/1.73m2had higher odds of adverse outcomes.2nd trimester eGFR may be a helpful tool to identify women with SLE at greater risk for adverse outcome.Our results further suggest that kidney hyperfiltration may become pathologic during pregnancy.There were notable differences using non-race based and race-based GFR estimating equations.These differences may have clinical implications when utilizing GFR estimating equations to predict health outcomes.

Association of 2nd Trimester eGFR and Adverse Outcomes
eGFR strata
Preterm Birth
Unadjusted OR
(95%CI)
Preeclampsia
Unadjusted OR
(95%CI)
Fetal Loss
Unadjusted OR
(95%CI)
Poor Pregnancy Outcome
Unadjusted OR
(95%CI)
Very Low eGFR<903.16 (1.63, 6.12)2.91 (1.32, 6.37)5.82 (2.28, 14.86)3.79 (2.00, 7.19)
Low
eGFR90-120
1.01 (0.67, 1.51)0.83 (0.46, 1.52)0.55 (0.19, 1.60)0.92 (0.62, 1.35)
Normal
eGFR 121-135
1.01.01.01.0
Very High
eGFR>135
2.80 (1.55, 5.06)1.69 (0.75, 3.81)0.50 (0.06, 3.92)2.19 (1.22, 3.92)

Funding

  • Private Foundation Support