SS Nefrologia Department of Clinical and Biological Sciences, ASOU San Luigi Gonzaga, University of Torino, Italy.
Nephrol Dial Transplant. 2012 Oct;27 Suppl 3:iii111-8. doi: 10.1093/ndt/gfs302. Epub 2012 Jul 6.
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.
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).
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.
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.
慢性肾脏病（CKD）在妊娠中具有较高的发病率。在成本受限的时期，需要确定风险模式并进行随访。
根据 K-DOQI 指南对患者进行分期。该分析为前瞻性研究，时间范围为 2000 年 1 月至 2011 年 6 月。共观察了 225 例 CKD 患者的 249 例妊娠，记录了 176 例单胎分娩。最大的一组是肾功能正常的 1 期 CKD 患者，其中记录了 127 例单胎分娩。没有发生严重结局（死亡；透析）；因此，分析了替代结局[剖宫产、早产、需要新生儿重症监护病房（NICU）]。将 1 期患者与正常对照组（267 例在同一环境中随访的低危妊娠）和 CKD 2-4 期患者（49 例单胎分娩）进行比较；还分析了两种转诊模式（已知诊断；新诊断）。
与对照组相比，1 期 CKD 患者不良妊娠的风险显著增加：剖宫产的优势比为 2.73（1.72-4.33）；早产为 8.50（4.11-17.57）；NICU 为 16.10（4.42-58.66）。风险在后期增加。新的 CKD 诊断率较高（总体：38.6%；1 期：43.3%）；两种转诊模式之间没有发现显著的结局差异。高血压和蛋白尿被证实为独立的危险因素。
CKD 是妊娠的危险因素；所有患者都应在 1 期开始在专门的项目中进行随访。需要为早期 CKD 阶段制定专门的干预和教育计划，以最大限度地发挥诊断和治疗潜力。
