慢性肾脏病3至5期的妊娠：胎儿及母体结局
Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes.
作者信息
Imbasciati Enrico, Gregorini Gina, Cabiddu Gianfranca, Gammaro Linda, Ambroso Giancarlo, Del Giudice Antonio, Ravani Pietro
机构信息
Renal Unit, Ospedale di Lodi, Italy.
出版信息
Am J Kidney Dis. 2007 Jun;49(6):753-62. doi: 10.1053/j.ajkd.2007.03.022.
BACKGROUND
Prognostic criteria to inform women with moderate to severe renal insufficiency who wish to bear children are not well established.
STUDY DESIGN
Longitudinal multicenter cohort study.
SETTINGS & PARTICIPANTS: Nondiabetic white women with pregnancies proceeded beyond the 20th week and estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m(2) (<1 mL/s/1.73 m(2)) before conception.
PREDICTORS
Baseline GFR and proteinuria (exposure); other clinical characteristics at conception (covariates).
OUTCOMES & MEASUREMENTS: Difference in GFR decreases before conception versus after delivery (mixed linear models); low birth weight (<2,500 g), and maternal renal survival (logistic and Cox regressions).
RESULTS
49 women were studied. Mean serum creatinine and GFR at conception were 2.1 +/- 1 (SD) mg/dL (186 +/- 88 micromol/L) and 35 +/- 12 mL/min/1.73 m(2) (0.58 +/- 0.2 mL/s/1.73 m(2)), respectively. Overall mean GFR after delivery was less than before conception (30 +/- 13.8 versus 35 +/- 12.2 mL/min/1.73 m(2) [0.50 +/- 0.23 versus 0.58 +/- 0.20 mL/s/1.73 m(2)]; P < 0.001), but the rate of GFR decrease did not change (0.55 +/- 0.8 versus 0.50 +/- 0.3 mL/min/mo [0.0092 +/- 0.013 versus 0.0083 +/- 0.005 mL/s/mo]; P = 0.661). Independent of potential confounders, the combined presence of baseline GFR less than 40 mL/min/m(2) (<0.67 mL/s/m(2)) and proteinuria with protein greater than 1 g/d, but not either factor alone, predicted faster GFR loss after delivery compared with before conception (1.17 +/- 1.23 versus 0.55 +/- 0.39 mL/min/mo; difference, 0.62 mL/min/mo; 95% confidence interval [CI], 0.27 to 0.96 mL/min/mo [0.020 +/- 0.021 versus 0.0092 +/- 0.007 mL/s/mo; difference, 0.10 mL/s/mo; 95% CI, 0.005 to 0.016 mL/s/mo]). The presence of both risk factors, but not either alone, also predicted shorter time to dialysis therapy or GFR halving (N = 20; hazard ratio, 5.2; 95% CI, 1.7 to 15.9) and low birth weight (N = 29; odds ratio, 5.1; 95% CI, 1.03 to 25.6).
LIMITATIONS
Generalizability to other settings; study power.
CONCLUSION
In women with renal insufficiency, the presence of both GFR less than 40 mL/min/1.73 m(2) (<0.67 mL/s/m(2)) and proteinuria with protein greater than 1 g/d before conception predicts poor maternal and fetal outcomes.
背景
对于希望生育的中重度肾功能不全女性，目前尚未建立完善的预后标准。
研究设计
纵向多中心队列研究。
研究地点与参与者
非糖尿病白人女性，妊娠超过20周，且孕前估计肾小球滤过率（GFR）低于60 mL/min/1.73 m²（<1 mL/s/1.73 m²）。
预测因素
基线GFR和蛋白尿（暴露因素）；受孕时的其他临床特征（协变量）。
结局与测量指标
孕前与产后GFR下降的差异（混合线性模型）；低出生体重（<2500 g）以及母亲肾脏存活情况（逻辑回归和Cox回归）。
结果
共研究了49名女性。受孕时的平均血清肌酐和GFR分别为2.1±1（标准差）mg/dL（186±88 μmol/L）和35±12 mL/min/1.73 m²（0.58±0.2 mL/s/1.73 m²）。产后总体平均GFR低于孕前（30±13.8对比35±12.2 mL/min/1.73 m² [0.50±0.23对比0.58±0.20 mL/s/1.73 m²]；P<0.001），但GFR下降速率未改变（0.55±0.8对比0.50±0.3 mL/min/月 [0.0092±0.013对比0.0083±0.005 mL/s/月]；P = 0.661）。独立于潜在混杂因素，基线GFR低于40 mL/min/m²（<0.67 mL/s/m²）且蛋白尿大于1 g/d同时存在，但单独任何一个因素均不能预测产后与孕前相比GFR下降更快（1.17±1.23对比0.55±0.39 mL/min/月；差值为0.62 mL/min/月；95%置信区间[CI]，0.27至0.96 mL/min/月 [0.020±0.021对比0.0092±0.007 mL/s/月；差值为；0.10 mL/s/月；95% CI，0.005至0.016 mL/s/月]）。两个危险因素同时存在，但单独任何一个均不能预测透析治疗时间缩短或GFR减半（N = 20；风险比，5.2；95% CI，1.7至15.9）以及低出生体重（N = 29；比值比，5.1；95% CI，1.03至25.6）。
局限性
对其他情况的可推广性；研究效能。
结论
对于肾功能不全女性，孕前GFR低于40 mL/min/1.73 m²（<0.67 mL/s/m²）且蛋白尿大于1 g/d同时存在预示着不良的母婴结局。
Zotero 插件