Is renal hyperfiltration protective in chronic kidney disease‐stage 1 pregnancies? A step forward unravelling the mystery of the effect of stage 1 chronic kidney disease on pregnancy outcomes

Lee

et al. 2018

Kidney Blood Press Res

Background/Aims: The association between gestational estimated glomerular filtration rate (eGFR) and adverse pregnancy outcomes has not been fully investigated. Methods: This observational cohort study included pregnancy cases of singleton mothers whose serum creatinine levels were measured during pregnancy at two tertiary hospitals in Korea from 2000 to 2015. Those with identified substantial renal function impairment (eGFR < 60 mL/min/1.73 m² at baseline, during, or after pregnancy) were excluded. The Chronic Kidney Disease Epidemiology Collaboration equation was used for the eGFR calculation. We computed the time-averaged eGFR during gestation to determine representative values when there were multiple measurements. We studied the following three gestational complications: preterm birth (< 37 weeks’ gestational age), low birth weight (< 2.5 kg), and preeclampsia. Results: Among the 12,899 studied pregnancies, 4,360 cases experienced one or more gestational complications. The adjusted odds ratio (aOR) and 95% confidence interval of composite gestational complications for eGFR ranges other than the reference range of 120–150 mL/ min/1.73m² were: ≥150 mL/min/1.73m², aOR 1.64 (1.38–1.95), P< 0.001; 90–120 mL/min/1.73m², aOR 1.41 (1.28–1.56), P< 0.001; and 60–90 mL/min/1.73m², aOR 2.56 (1.70–3.84), P< 0.001. Incidence of preterm birth or low birth weight showed similar U-shaped association with eGFR values; otherwise, preeclampsia or small for gestational age occurred more often in mothers with a lower gestational eGFR than in those with a higher value. Conclusion: Considering the unique association between gestational eGFR and pregnancy outcomes, carefully interpreting these results may help predict obstetric complications.

Section: Park Et Al: Pregnancy Complications and Gestational Egfrmentioning

confidence: 99%

Gestational Estimated Glomerular Filtration Rate and Adverse Maternofetal Outcomes

Lee

et al. 2018

Kidney Blood Press Res

American Journal of Kidney Diseases

“…urinalysis or radiologic findings) but preserved GFR) had a higher risk of preterm birth, lower birth weight and admission to the neonatal intensive care unit. 4 In our cohort, we also did not have any women with diabetes and all of the participants had normal kidney function. Additionally, in our study none of the women had proteinuria at baseline.…”

Section: Discussionmentioning

confidence: 99%

“…17-19 However, a recent study of pregnant patients with CKD stage 1 did not find any difference in pregnancy-related outcomes between patients with or without a hyperfiltration response. 4 Hence, other mechanisms such as endothelial damage, inflammation, and oxidative stress (all of which occur even with mild kidney damage) may be contributing to adverse pregnancy outcomes in patients with early stage CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, we identified hypertension, diabetes, proteinuria, and kidney function by ICD-9 code. The importance of these variables on pregnancy outcomes has been well described 1-4,12,20,21 and miscoding of these data may have occurred in the dataset. Approximately 30% of women with unilateral renal agenesis have associated uterine/mullerian anomalies, 22 which can contribute to preterm births and to increased cesarean sections (due to malpresentation).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, it has been shown that adverse outcomes occur even with only mild kidney damage and normal glomerular filtration rate (GFR). 1-4 …”

mentioning

confidence: 99%

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Association of Unilateral Renal Agenesis With Adverse Outcomes in Pregnancy: A Matched Cohort Study

Kendrick

Holmén

You

et al. 2017

Background Data regarding the effect of a solitary kidney during pregnancy have come from studies of living kidney donors. We evaluated the risk of adverse pregnancy outcomes in women with a single kidney from renal agenesis. Study Design Matched cohort study. Setting and Participants Using data from 7,079 childbirths from an integrated health care delivery system from 1996 through 2015, we identified births from women with renal agenesis. Only first pregnancies and singleton births were included. After excluding those with diabetes and kidney disease, a total of 200 women with renal agenesis were matched 1:4 by age (within 2 years), race, and history of hypertension to women with two kidneys. Predictor Renal agenesis defined by ICD-9 codes prior to pregnancy. Outcomes The primary outcome was adverse maternal outcomes including preterm delivery, delivery via cesarean section, preeclampsia/eclampsia, and length of stay at hospital. Adverse neonatal endpoints were considered as a secondary outcome and included low birth weight (<2,500 g) and infant death/transfer to acute inpatient facility. Results The mean gestational age at delivery was 37.9 ± 2.1 weeks for women with renal agenesis compared to 38.6 ± 1.8 weeks for women with two kidneys. Compared to women with two kidneys, those with renal agenesis had an increased risk of preterm delivery (OR, 2.88; 95% CI, 1.86-4.45), delivery via cesarean section (OR, 2.11; 95% CI, 1.49-2.99), preeclampsia/eclampsia (OR, 2.41; 95% CI, 1.23-4.72), and length of stay >3 days (OR, 1.81; 95% CI, 1.18-2.78). Renal agenesis was not significantly associated with an increased risk of infant death/transfer to acute facility (OR, 2.60; 95% CI, 0.57-11.89) or with low birth weight after accounting for preterm delivery (OR, 2.11; 95% CI, 0.76-5.88). Limitations Renal agenesis was identified by ICD-9 code not by abdominal imaging. Conclusion Women with unilateral renal agenesis have a higher risk of adverse outcomes in pregnancy.

TheGCKRGene Polymorphism rs780094 is a Risk Factor for Gestational Diabetes in a Brazilian Population

Anghebem-Oliveira

Webber

Alberton

et al. 2016

J. Clin. Lab. Anal.