ADVERSE MATERNAL AND FETAL OUTCOMES IN PREGNANT PATIENTS WITH CHRONIC KIDNEY DISEASE

The diagnostic of chronic kidney disease increases adverse maternal and fetal outcomes in pregnant patients. The most frequently associated factors with adverse outcomes have been elevated serum creatinine, elevated BUN, proteinuria, and hypertension. However, little has been studied in Latin America about the impact of chronic kidney disease and factors associated with adverse maternal and fetal outcomes.

Retrospective study in clinical records of patients with pregnancy and chronic kidney disease. The cut-off level for serum creatinine, BUN, and proteinuria was determined using ROC curves. Odds ratio with 95% confidence interval was calculated to evaluate the association with maternal outcomes (abortion, cesarean section, preterm birth, preeclampsia) and fetal outcomes (live birth, low birth weight, admission to neonatal intensive care unit [NICU], neonatal death). Finally, outcomes were evaluated by KDIGO chronic kidney disease stage.

502 pregnancies in 488 patients were included. The most frequent adverse maternal outcomes were cesarean section (378 cases, 75.3%), preterm birth (218 cases, 43.4%), preeclampsia (147 cases, 29.3%) and abortion (19 cases, 3.8%). While among the fetal outcomes, the percentage of live births was 96.8%, low birth weight was the most common adverse fetal outcome (216 cases, 43.0%), followed by neonatal admission to the NICU (129 cases, 25.7%), and neonatal death (39 cases, 7.8%). The factors associated with adverse maternal and fetal outcomes were serum creatinine >1.20mg/dL, BUN 18.93 mg/dL, proteinuria >1.15 g/24 hours and hypertension. Serum creatinine >1.20mg/dL was associated with preterm delivery (OR: 2.259, IC95%: 1.545-3.303), low birth weight (OR: 2.674, IC95%: 1.807-3.956), admission to NICU (OR: 1.811, IC95%: 1.177-2.788), neonatal death (OR: 3.641, IC95%: 1.570-8.442). While the BUN >18.93 mg/dL was associated with preterm delivery (OR: 3.054, IC95%: 2.083-4.478), abortion (OR: 3.240, IC95%: 1.059-9.909), preeclampsia (OR: 2.075, IC95%: 1.379-3.123), low birth weight (OR: 4.055, IC95%: 2.719-6.046), admission to NICU (OR: 2.535, IC95%: 1.641-3.918), neonatal death (OR: 6.602, IC95%: 2.531-17.220). Regarding proteinuria >1.15 g/24 hours was associated with preterm delivery (OR: 1.917, IC95%: 1.321-2.784), preeclampsia (OR: 2.477, IC95%: 1.642-3.737), low birth weight (OR: 2.280, IC95%: 1.553-3.348), admission to NICU (OR: 2.119, IC95%: 1.381-3.252). Finally, hypertension was associated with preterm delivery (OR: 1.909, IC95%: 1.273-2.861), preeclampsia (OR: 2.797, IC95%: 1.852-4.225), low birth weight (OR: 2.232, IC95%: 1.471-3.386), admission to NICU (OR: 2.440, IC95%: 1.588-3.750), neonatal death (OR: 2.569, IC95%: 1.323-4.988). Maternal and fetal outcomes increase with CKD stage.

Adverse maternal and fetal outcomes were associated with serum creatinine >1.20mg/dL, BUN >18.93 mg/dL, proteinuria >1.15 g/24 hours and hypertension. Adverse outcomes increase with CKD stage.