Kidney Week

Abstract: TH-PO1009

Personalized Approach to Pregnancy with Focus on Patients with Advanced CKD (Stages 3-5): Revisiting the Risks

Session Information

• Women's Health and Kidney Diseases
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women's Health and Kidney Diseases

• 2200 Women's Health and Kidney Diseases

Authors

• Piccoli, Giorgina B., Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France

Giorgina B. Piccoli, MD

• Mariani, Chiara, Umberto I Policlinico di Roma, Rome, Lazio, Italy

Chiara Mariani, MD

• Salomone, Mario, Societa Italiana di Nefrologia, Rome, Lazio, Italy

Mario Salomone, MD

• Rocca, Anna Rachele, Umberto I Policlinico di Roma, Rome, Lazio, Italy

Anna Rachele Rocca

Background

Chronic kidney disease (CKD) is a well-acknowledged risk factor for several adverse pregnancy outcomes (APOs). While the increased risk is well-known, its entity, modifiers, and the relationship between maternal kidney disease and pregnancy complications are only partially known.

Methods

We analyse the clinical data of women with known CKD and pregnancies which continued beyond the 20^th gestational week (GW). The clinical outcome considered was loss of maternal kidney function 1 year after delivery (start of dialysis, loss of ≥10 ml/min of eGFR from the pre-pregnancy baseline data). Covariates were age, partity, CKD stage and pregnancy outcomes: preterm (<37GW), early and very-early (<34 and <28GW) preterm delivery, preeclampsia (PE), combined adverse neonatal outcomes (intrauterine or neonatal death, birth weight centile<10^th, or birth-weigh <2.5kg). Univariable and multivariable regression analysis (stepwise backwards model) were performed.

Results

Out of 147 pregnancies, 44 in mothers with CKD stages 3-5 before pregnancy, 124 completed 1 year of follow-up. More than half were affected by immunologic glomerulopathies or had received a kidney transplantation. In the context of a high prevalence of preterm delivery (73% in stage 3-5, 29% in stage 1-2), PE occurrence was 25% in patients with CKD stage 3-5 and 11% in lower CKD stages. Four intrauterine deaths were reported in the context of PE, not related to urea levels. The risk of APOs was modulated by the degree of CKD and the presence/severity of arterial hypertension and proteinuria. In stages 3-5, 31% of patients lost ≥10 ml/min of eGFR or started dialysis within 1 year after delivery, in stages 1-2 19.5%. A complicated pregnancy (delivery <34GW or intrauterine/perinatal death or birth weight <10^th centile or <2.5kg) was associated with an increased risk of reduction ≥10 ml/min of eGFR or initiation of dialysis within 1 year of delivery (OR 3.623,95%CI 1.335-10.315, p 0.0127). One patient stared dialysis in pregnancy. Four patients started dialysis within the first year after delivery.

Conclusion

The risk of reduction of eGFR or initiation of dialysis is higher in women who expereinced a complicated pregnancy. The identification of APOs as risk factors for eGFR reduction in the first year after delivery is of importance for modulating post-pregnancy follow-up.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025y79h8n54