Pregnancy in patients with chronic kidney disease: Maternal and fetal outcomes.

Abstract

Chronic kidney diseases (CKD) adversely affects fetal and maternal outcomes during pregnancy. We retrospectively reviewed the renal, maternal and fetal outcomes of 51 pregnancies in women with CKD between July 2009 and January 2012. Of the 51 subjects (mean age 27.8 ± 7.04), 32 had 19 had estimated glomerular filtration rate (eGFR) <60 ml/min. There was significantly greater decline in eGFR at 6 weeks (55.8 ± 32.7 ml/min) after delivery as compared to values at conception (71.7 ± 27.6 [P < 0.001]). The average decline of GFR after 6 weeks of delivery was faster in patients with GFR < 60 ml/min/1.73 m2 at −18.8 ml/min (stage 3, n = 13, −20.2 ml/min; stage 4, n = 6, −15.8 ml/min) as compared to −15.1 ml/min in patients with GFR ≥ 60 ml/min/1.73 m2. Three of the six patients (50%) in stage 4 CKD were started on dialysis as compared to none in earlier stages of CKD (P = 0.002). At the end of 1 year, all patients in stage 4 were dialysis dependent, while only 2/13 in stage 3 were dialysis dependent (Odds ratio 59.8, 95% confidence interval 2.8–302, P = 0.001). Preeclampsia (PE) was seen in 17.6%. Only 2/32 (6.25%) patients with GFR ≥ 60 ml/min/1.73 m2 developed PE while 7/19 (36.84%) patients with GFR < 60 ml/min developed PE. Of the 51 pregnancies, 15 ended in stillbirth and 36 delivered live births. Eleven (21.56%) live-born infants were delivered preterm and 7 (13.72%) weighed < 2,500 g. The full-term normal delivery was significantly high (50%) in patients with GFR ≥ 60 ml/min/1.73 m2 (P = 0.006) and stillbirth was significantly high - 9/19 (47.36%) patients with GFR < 60 ml/min/1.73 m2. To conclude, women with CKD stage 3 and 4 are at greater risk of decline in GFR, PE and adverse maternal and fetal outcomes as compared to women with earlier stages of CKD.