Abstract
Background
Studies among pregnant Asian women with chronic kidney disease (CKD) have not been widely performed; therefore, clinical criteria for these patients have not been well established.
Methods
We conducted a retrospective study among pregnant women with CKD who received prenatal care at our institution for 8 consecutive years. Primary outcome was the development of severe adverse events (SAEs). We analyzed correlations between primary outcome and CKD parameters [age, body mass index (BMI), estimated glomerular filtration rate (eGFR), urinary protein–creatinine ratio (UP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and not normal blood pressure (non-NBP)] at the time of referral. Secondary outcomes were low birth weight (LBW), preterm delivery (PreD), and small for gestational age (SGA). We divided into two categories, CKD stage G1, and G2 or higher according to eGFR, and proteinuria negative and proteinuria positive according to UP, respectively.
Results
We observed 89 pregnancies. SAE was observed in 28 pregnancies. In live birth cases, there were 28 PreD, 28 LBW and 13 SGA. Major SAEs included preeclampsia, superimposed preeclampsia, unscheduled cesarean section, neonatal intensive care unit admission, and fetal death. Stepwise logistic regression analysis selected eGFR (OR = 0.847, p = 0.026), SBP (OR = 1.897, p = 0.006) and proteinuria positive (OR = 2.96, p = 0.046) as the significant predictors of SAEs. There were no significant differences among the baseline characteristics stratified by SGA.
Conclusions
This is the first study to report pregnancy outcomes among Japanese non-disease-oriented patients with CKD. In Asians, especially in the Japanese population, kidney function, blood pressure and proteinuria might affect pregnancy outcomes.
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Acknowledgements
We would like to acknowledge the staff of the medical record services for their contribution in providing the old medical records for the collection of data. The data of this study were preliminary presented at the American Society of Nephrology Congress, Kidney Week 2018, in San Diego, California, USA, October 23–28. Also, we would like to thank Editage (http://www.editage.jp) for English language editing.
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SK, TN, TN, KO, TH, MS and MM were involved in design of the work and interpretation of the data. SK, MS, KO analyzed the data. All authors were involved in drafting or revising the manuscript and approved the final version.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval no. 2017-1-934 at Ethics committee of Tohoku University School of Medicine) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Kumakura, S., Okamoto, K., Takeuchi, S. et al. Kidney function, blood pressure and proteinuria were associated with pregnancy outcomes of pregnant women with chronic kidney disease: a single-center, retrospective study in the Asian population. Clin Exp Nephrol 24, 547–556 (2020). https://doi.org/10.1007/s10157-020-01865-0
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DOI: https://doi.org/10.1007/s10157-020-01865-0