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Kidney Week

Abstract: FR-PO865

Women with Preexisting CKD and a History of Preeclampsia Have a High Rate of Subsequent Pregnancy Complications but Are Seldom Linked to Adequate Care

Session Information

Category: Women's Health and Kidney Diseases

  • 2200 Women's Health and Kidney Diseases

Authors

  • Gupta, Sonali, Albert Einstein College of Medicine, Bronx, New York, United States
  • Jim, Belinda, Albert Einstein College of Medicine, Bronx, New York, United States
  • Golestaneh, Ladan, Albert Einstein College of Medicine, Bronx, New York, United States
Background

Pregnancy provides a unique opportunity to identify patients with undiagnosed CKD, which includes ongoing proteinuria from previous pre-eclampsia episode, and integrate them with healthcare resources. Pregnant women with pre-existing CKD and a history of pre-eclampsia have a high incidence of adverse outcomes but whether these outcomes occur despite adequate linkage to care is not known.

Methods

We evaluated a retrospective cohort of pregnant women with preexisting CKD (as defined by eGFR<60 or proteinuria >200mg within 6 months and 5 years prior to admission) and a previous history of preeclampsia who were hospitalized in a large New York City health system in Bronx, NY, between January 1, 2016 and December 31, 2019. Data on socio-demographic variables, comorbidities, pregnancy complications, and follow up within 2 years post-discharge was extracted from Looking Glass©, a combined clinical and claims database. Descriptive analyses showed proportion with at least one visit to primary care or nephrology and an instance of proteinuria checked within 2 years in those with preeclampsia and CKD.

Results

We identified 296 hospitalized pregnant women with a history of pre-eclampsia and CKD of which 2.9% were White, 40.5% were Black, and 46.9% were Hispanic. Median eGFR among those with CKD defined by eGFR only was 42.5 (IQR 38-50), while mean proteinuria for all was 469 mg (IQR 325-862). Median age was 30 yrs (IQR 26-34), and mean BMI 34.0 (SD 7.1). Coexisting comorbidities included hypertension in 49.3 %, diabetes in 5.1%, heart failure in 1.0%, and lupus in 1.7% of patients. Overall, 87.5% of patients had at least one pregnancy complication. The most common complications were preeclampsia during current pregnancy (86.4%), followed by oligohydramnios (5.8%) and preterm labor (3.8%). Of this group, 65 (22.0%) had a clinic visit with primary care/nephrology post discharge, and 149 (50.3%) had proteinuria checked within 2 years. Mean time to first clinic visit was 29.2 days (SD 15.9).

Conclusion

Pregnant patients with prior CKD and pre-eclampsia are at high risk of pregnancy complications, yet only a small proportion are linked to care. There is a dire need for patient centered medical care among pregnant women with CKD, to improve clinical outcomes.