Pregnancy in chronic kidney disease stage 4: a case series from a referral center; [Беременность при ХБП 4 стадии: серия наблюдений специализированного нефрологического центра]

Objective: pregnancy in women with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus. Setting of care is a potential determinant of the results, but data about pregnancy course in different settings are still limited. In this retrospective study, we aimed to analyze the course and outcomes of pregnancy in women with CKD stage 4 followed-up in a referral center in Russia. Materials and methods: thirteen pregnant women with CKD stage 4 were followed in a dedicated unit for pregnant women with kidney diseases. Main data collected: CKD cause, obstetric history, pre-gestational serum creatinine (sCr), week of gestation at the first visit, proteinuria, sCr and blood pressure (BP) at referral and each trimester, type and week of delivery and pregnancy outcome. Physiological kidney response to pregnancy was considered as a persistent decrease of SCr by ≥10 μmol/L from the pre-gestational level. Superimposed PE was diagnosed based on the abrupt increase of blood pressure, proteinuria and/or sCr, together with alteration of the angiogenic-antiangiogenic ratio, whenever available. Pregnancy management included BP control, anemia correction, antiplatelet and anticoagulant therapy, and urinary tract infection treatment. Results: arterial hypertension was present at referral in 6/13 cases, the mean BP decreased by the 3-rd trimester under treatment. Proteinuria increased during pregnancy in all cases, more rapidly in women who subsequently developed preeclampsia. Mean sCr at referral to the center was 184±13.3 μmol/L, urea 9.8±0.6 mmol/l, eGFR 32.9±2.9 ml/min/1.73 m2. Postpartum sCr increased to 243.4±37.8 μmol/L, urea 11.9±0.7 mmol/L, and eGFR dropped to 21.8±1.4 ml/min/1.73 m2. Median term of delivery was 34 weeks of gestation. Superimposed preeclampsia was diagnosed in 6 cases. All newborns were alive and viable. None of the patients needed dialysis during pregnancy or immediately after delivery. Conclusion: a favorable pregnancy outcome, defined as a viable baby without major health issues, is possible in women with CKD stage 4, however prematurity is common, and a decrease in the kidney function is observed in most of the cases. © 2023 JSC Vidal Rus. All rights reserved.