title: Pregnancy in CKD: whom should we follow and why?
abstract: BACKGROUND
  Chronic kidney disease (CKD) has a high prevalence in pregnancy. In a period of cost constraints, there is the need for identification of the risk pattern and for follow-up.
  
  
  METHODS
  Patients were staged according to K-DOQI guidelines. The analysis was prospective, January 2000-June 2011. Two hundred and forty-nine pregnancies were observed in 225 CKD patients; 176 singleton deliveries were recorded. The largest group encompasses stage 1 CKD patients, with normal renal function, in which 127 singleton deliveries were recorded. No hard outcomes occurred (death; dialysis); therefore, surrogate outcomes were analysed [caesarean section, prematurity, need for neonatal intensive care unit (NICU)]. Stage 1 patients were compared with normal controls (267 low-risk pregnancies followed in the same setting) and with patients with CKD stages 2-4 (49 singleton deliveries); two referral patterns were also analysed (known diagnoses; new diagnoses).
  
  
  RESULTS
  The risk for adverse pregnancy rises significantly in stage 1 CKD, when compared with controls: odds ratios were caesarean section 2.73 (1.72-4.33); preterm delivery 8.50 (4.11-17.57); NICU 16.10 (4.42-58.66). The risks rise in later stages. There is a high prevalence of new CKD diagnosis (overall: 38.6%; stage 1: 43.3%); no significant outcome difference was found across the referral patterns. Hypertension and proteinuria are confirmed as independent risk factors.
  
  
  CONCLUSIONS
  CKD is a risk factor in pregnancy; all patients should be followed within dedicated programmes from stage 1. There is need for dedicated interventions and educational programmes for maximizing the diagnostic and therapeutic potentials in early CKD stages.
authors: SS Nefrologia Department of Clinical and Biological Sciences, ASOU San Luigi Gonzaga, University of Torino, Italy. giorgina.piccoli@unito.it
authors: Giorgina Barbara
authors: GB
authors: Piccoli
authors: Federica
authors: F
authors: Fassio
authors: Rossella
authors: R
authors: Attini
authors: Silvia
authors: S
authors: Parisi
authors: Marilisa
authors: M
authors: Biolcati
authors: Martina
authors: M
authors: Ferraresi
authors: Arianna
authors: A
authors: Pagano
authors: Germana
authors: G
authors: Daidola
authors: Maria Chiara
authors: MC
authors: Deagostini
authors: Piero
authors: P
authors: Gaglioti
authors: Tullia
authors: T
authors: Todros
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors