title: Impact of early chronic kidney disease on maternal and fetal outcomes of pregnancy.
abstract: BACKGROUND
  Elevated serum creatinine is associated with higher maternal and fetal risks; however, the influence of milder degree of renal impairment diagnosed on basis on estimated glomerular filtration rate (eGFR) is less well defined. This study assesses the impact of early chronic kidney disease (CKD) utilizing eGFR in predicting adverse outcomes in women with CKD.
  
  
  METHODS
  We analyzed outcomes of 98 pregnant women with CKD. Women with CKD stage 1 were used as control.
  
  
  RESULTS
  Women with eGFR of 60?89 ml/min were at an increased risk for deterioration of renal function, preeclampsia, and cesarean section. The odd ratios for composite maternal complication of worsening of renal function or preeclampsia were 6.75 (95% confidence interval (CI), 1.84-24.80) in women with eGFR of 60?89. Similarly, women with an eGFR of 60?89 had a significantly increased risk for intrauterine growth restriction (38.5%), preterm birth (31.2%), and intrauterine fetal death (15.8%). The odds for composite fetal adverse outcomes were 2.91 (95% CI, 1.19-7.09) in women with eGFR of 60?89.
  
  
  CONCLUSIONS
  Early CKD increases the risk of adverse outcomes in pregnancy. Estimated GFR ranging between 60?89 ml/min/1.73 m(2) is associated with significant maternal and fetal complications. The risk of adverse outcomes in pregnant women with early CKD can be more accurately stratified by using estimated GFR than the serum creatinine alone.
authors.affiliation: Department of Medicine, King Saud University, Riyadh , Saudi Arabia. suwaida@ksu.edu.sa
authors.forename: Abdulkareem
authors.initials: A
authors.lastname: Alsuwaida
authors.forename: Dujanah
authors.initials: D
authors.lastname: Mousa
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Harbi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alghonaim
authors.forename: Sumaya
authors.initials: S
authors.lastname: Ghareeb
authors.forename: Mona N
authors.initials: MN
authors.lastname: Alrukhaimi
mesh_terms: D000328:Adult; D017668:Age of Onset; D016022:Case-Control Studies; D005260:Female; D005865:Gestational Age; D005919:Glomerular Filtration Rate; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D033261:Maternal-Fetal Relations / Q000502:physiology; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011379:Prognosis; D013997:Time Factors