Risk of adverse maternal and fetal outcomes during pregnancy in living kidney donors: A matched cohort study

Davis, Scott; Dylewski, James; Shah, Pratik; Holmén, John; You, Zhiying; Chonchol, Michel; Kendrick, Jessica

doi:10.1111/ctr.13453

Cited by 19 publications

(12 citation statements)

References 31 publications

(42 reference statements)

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“…30 Three studies compared outcomes to the general population. 26 The risk of pre-eclampsia/eclampsia was not statistically different between the groups (OR: 2.96, 95% CI: 0.98-8.94, p = .06). LKD ≤30 years, had a four-fold increased risk of pre-eclampsia/eclampsia (OR: 4.09, 95% CI: 1.07-15.59, p = .04).…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 83%

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Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance

Pippias

Skinner

Noordzij

et al. 2022

American Journal of Transplantation

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Understanding and communicating the risk of pregnancy complications post‐living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post‐donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English‐language publications published up until December 18, 2020. Ninety‐three articles were screened from which 16 studies were identified, with a total of 1399 post‐donation pregnancies. The outcome of interest, post‐donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre‐eclampsia increased from ~1%–3% pre‐donation (lower than the general population) to ~4%–10% post‐donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post‐donation and pre‐donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post‐donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post‐donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.

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Section: Ta B L E 1 (Continued)mentioning

confidence: 83%

“…Davis et al (2019) using the Intermountain Healthcare Enterprise Data Warehouse, compared pregnancy outcomes in 59 LKD (≥2 years after donation) with 236 age‐ and race‐matched controls 26 . The risk of pre‐eclampsia/eclampsia was not statistically different between the groups (OR: 2.96, 95% CI: 0.98–8.94, p = .06).…”

Section: Resultsmentioning

confidence: 99%

Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance

Pippias

Skinner

Noordzij

et al. 2022

American Journal of Transplantation

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“…The Ontario study found an increased risk of gestational hypertension or preeclampsia in donors > 32 years of age 13 . By contrast, recent study reported that first childbirth before 30 years of age is a risk factor for preeclampsia and eclampsia in donors 28 . In this study, multivariable analysis revealed that primipara and time from donation to delivery (< 5 years) were significantly associated with increased risk of preeclampsia.…”

Section: Discussionmentioning

confidence: 76%

Pregnancy outcomes after living kidney donation from a nationwide population-based cohort study from Korea

Lee

Huh

Yoon

et al. 2022

Sci Rep

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While most living kidney donors experience good outcomes and high rates of satisfaction, kidney donation can increase the risk of gestational hypertension or preeclampsia. However, pregnancy outcomes in non-white donors are limited. We conducted a nationwide cohort study of 112 living kidney donors and 672 matched healthy non-donors using the Korean National Health Insurance Claims Database. Donors and healthy non-donors were matched according to age, year of cohort entry, residency, income, number of pregnancies, and the time to the first pregnancy after cohort entry. We assessed pregnancy outcomes of live kidney donors compared with matched healthy non-donors using the nationwide database. Gestational hypertension or preeclampsia was more common in kidney donors than in non-donors (8.9% vs. 1.8%; adjusted odds ratio, 2.68; 95% confidence interval, 1.11–6.50). However, the incidence of severe gestational hypertension or preeclampsia that required antihypertensive medication was comparable (2.7% vs. 0.9%; P = 0.121). The time from donation to delivery within 5 years and primiparity were risk factors for preeclampsia in donors. Low birth weight, stillbirth, and ectopic pregnancy were not significantly different between the two groups. Maternal death occurred in two non-donor cases, but none occurred in donors compared to non-donors. Our findings indicate that kidney donors are associated with an increased risk of gestational hypertension or preeclampsia than matched healthy non-donors. However, the probabilities of serious maternal and fetal outcomes remained low and are not increased significantly after kidney donation.

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“…Independently from kidney function, the presence of kidney damage, or a reduction in kidney tissue, it is now known to be associated with an increased incidence of adverse pregnancy outcomes, including preterm delivery, preeclampsia, the hypertensive disorders of pregnancy, and giving birth to a small-for-gestational-age (SGA) baby [ 4 , 5 , 6 ]. This is also true of those who have a healthy single kidney (as is the case of kidney donors), and is observed, among others, in patients with kidney stones, and in cases with a previous episode of acute kidney injury (AKI), even after complete normalization of renal function [ 7 , 8 , 9 , 10 ]. The risk of adverse pregnancy outcomes is also higher in patients with kidney damage without hypertension, proteinuria, or loss of kidney function, and are further modulated by these three elements.…”

Section: Introductionmentioning

confidence: 99%

Plant-Based Diets Improve Maternal–Fetal Outcomes in CKD Pregnancies

Attini¹,

Leone²,

Chatrenet

et al. 2022

Nutrients

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Reducing protein intake in patients with chronic kidney disease (CKD) limits glomerular stress induced by hyperfiltration and can prevent the progression of kidney disease; data in pregnancy are limited. The aim of this study is to analyze the results obtained in CKD patients who followed a plant-based moderately protein-restricted diet during pregnancy in comparison with a propensity-score-matched cohort of CKD pregnancies on unrestricted diets. A total of 52 CKD pregnancies followed up with a protein-restricted plant-based diet (Torino, Italy) were matched with a propensity score based on kidney function and proteinuria with CKD pregnancies with unrestricted protein intake (Cagliari Italy). Outcomes included preterm (<37 weeks) and very preterm (<34 weeks) delivery and giving birth to a small-for-gestational-age baby. The median age in our cohort was 34 years, 63.46% of women were primiparous, and the median body mass index (BMI) was 23.15 kg/m2 with 13.46% of obese subjects. No statistical differences were found between women on a plant-based diet and women who were not in terms of age, parity, BMI, obesity, CKD stage, timing of referral, or cause of CKD. No differences were found between the two groups regarding the week of delivery. However, the combined negative outcome (birth before 37 completed gestational weeks or birth-weight centile <10) occurred less frequently in women following the diet than in women in the control group (61.54% versus 80.77%; p = 0.03). The lower risk was confirmed in a multivariable analysis adjusted for renal function and proteinuria (OR: 0.260 [Q1:0.093–Q3:0.724]; p = 0.010), in which the increase in proteinuria from the first to the last check-up before delivery was lower in patients on plant-based diets (median from 0.80 to 1.87 g/24 h; p: ns) than in controls (0.63 to 2.39 g/24 h p < 0.0001). Plant-based, moderately protein-restricted diets in pregnancy in patients with CKD are associated with a lower risk of preterm delivery and small-for-gestational-age babies; the effect may be mediated by better stabilization of proteinuria.

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Risk of adverse maternal and fetal outcomes during pregnancy in living kidney donors: A matched cohort study

Cited by 19 publications

References 31 publications

Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance

Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance

Pregnancy outcomes after living kidney donation from a nationwide population-based cohort study from Korea

Plant-Based Diets Improve Maternal–Fetal Outcomes in CKD Pregnancies

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