Pregnancy outcomes and chronic kidney disease: Ecuadorian single center experience .

BACKGROUND

Pregnancy is uncommon in women with chronic kidney disease (CKD), even more so in end-stage renal diseases (ESRD), and it is associated with high risks and complications that could lead to fetal and maternal morbidity or mortality and adverse outcomes.

MATERIAL AND METHODS

This was a descriptive observational study with 14 pregnant women with CKD. Comparison of clinical and biochemical variables between CKD-5D and non-dialysis dependent CKD patients was performed.Categorical variables were summarized as frequencies and percentages. For continuous variables, mean and standard deviation were reported. The significance of differences between groups was assessed by Student's t-test, and p-value ≤ 0.05 was considered statistically significant.

RESULTS

57% of patients (n = 8/14) were on chronic hemodialysis (HD). Mean time on dialysis was 11 ± 4 months. All HD patients were on intensified therapy (24 hours weekly) since 12 weeks of pregnancy. The presence of severe hypertension, valvular heart disease, diastolic dysfunction, activity of systemic lupus erythematosus, and abortions were more frequent in the HD-CKD group. Patients with CKD but no HD had decreased renal function. The mean gestational age at delivery and birth weight in the HD-CKD group was lower than in the non-HD-CKD group but without statistically significant differences. There were no neonatal or maternal deaths in either group.

DISCUSSION

Pregnancy in women with ESRD is complicated by increased adverse maternal and fetal outcomes, these remain high in women with kidney disease notwithstanding advances in obstetric and neonatal care. A HD condition seems to be related to worse outcomes. Preconception counseling and tight control after conception, including multidisciplinary evaluation and individualized therapy should be done.