Pregnancy and chronic kidney disease: a challenge in all CKD stages.
OBJECTIVE
Chronic kidney disease (CKD) is a challenge for pregnancy. Its recent classification underlines the importance of its early phases. This study's aim was to evaluate outcomes of pregnancy according to CKD stage versus low-risk pregnancies followed in the same center.


METHODS
The prospective analysis was conducted from January 2000 to May 2009 with the start of observation at referral and end of observation 1 month after delivery. Ninety-one singleton deliveries were studied; 267 "low-risk" singleton pregnancies served as controls. Because of the lack of hard end points (death, start of dialysis), surrogate end points were analyzed (cesarean section, prematurity, neonatal intensive care).


RESULTS
CKD outcome was worse than physiologic pregnancies: preterm delivery (44% versus 5%); cesarean section (44% versus 25%); and need for neonatal intensive care (26% versus 1%). The differences were highly significant in stage 1 CKD (61 cases) versus controls (CKD stage 1: cesarean sections = 57%, preterm delivery = 33%, intensive care = 18%). In CKD, proteinuria and hypertension were correlated with outcomes [proteinuria dichotomized at 1 g/24 h at referral: need for intensive care, relative risk (RR) = 4.16 (1.05 to 16.46); hypertension: preterm delivery, RR = 7.24 (2.30 to 22.79); cesarean section, RR = 5.70 (1.69 to 19.24)]. Statistical significance across stages was reached for preterm delivery [RR = 3.32 (1.09 to 10.13)].


CONCLUSIONS
CKD is a challenge for pregnancy from early stages. Strict follow-up is needed for CKD patients, even when there is normal renal function.
Piccoli
Giorgina Barbara
GB
Struttura Semplice Nefrologia Department of Clinical and Biological Sciences, Azienda Sanitaria Ospedaliera Universitaria San Luigi Gonzaga, University of Torino, Torino, Italy. gbpiccoli@yahoo.it
Attini
Rossella
R
Vasario
Elena
E
Conijn
Anne
A
Biolcati
Marilisa
M
D'Amico
Federica
F
Consiglio
Valentina
V
Bontempo
Salvatore
S
Todros
Tullia
T
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D003404:Creatinine