Analysis of the course and outcomes of pregnancy in patients with advanced stages chronic kidney disease

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Abstract

Background. Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited.

Aim. To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a–4.

Materials and methods. Thirty five pregnant women with CKD stages 3–4 were included: 3a – 12 (34.3%) patients, stage 3b – 10 (28.6%), stage 4 – 13 (37.1%).

Results. Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted.

Conclusion. A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.

About the authors

Kseniia A. Demyanova

People’s Friendship University of Russia; Eramishantsev City Clinical Hospital

Author for correspondence.
Email: ksedem@gmail.com
ORCID iD: 0000-0001-8927-5841

канд. мед. наук, ассистент каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Natalia L. Kozlovskaya

People’s Friendship University of Russia; Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0002-4275-0315

д-р мед. наук, проф., проф. каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, рук. Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Yuliia V. Korotchaeva

Eramishantsev City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University)

Email: ksedem@gmail.com
ORCID iD: 0000-0002-0880-6346

канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Sergei V. Apresyan

People’s Friendship University of Russia; Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0002-7310-974X

д-р мед. наук, проф. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН, зам. глав. врача по акушерско- гинекологической помощи ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Lidiia P. Rylceva

People’s Friendship University of Russia

Email: ksedem@gmail.com
ORCID iD: 0000-0001-6153-360X

студентка лечебного фак-та ФГАОУ ВО РУДН

Russian Federation, Moscow

Galina V. Usatenko

Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0003-4057-0190

зав. отд-нием ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow

Artem O. Lugovoj

Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0002-3344-7891

зав. отд-нием ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow

Mariia A. Vorobyeva

People’s Friendship University of Russia; Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0002-6932-2054

канд. мед. наук, ассистент каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, врач- терапевт ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Tatiana V. Bondarenko

Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0003-0701-1805

зав. отд-нием ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow

Anna V. Bespalova

Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0002-6993-6291

врач-нефролог ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow

Olga A. Volkova

Eramishantsev City Clinical Hospital

Email: ksedem@gmail.com
ORCID iD: 0000-0002-1996-2133

врач-нефролог ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Proteinuria in women with different stages of CKD by trimester.

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3. Fig. 2. Proteinuria in women with and without preeclampsia.

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4. Fig. 3. Blood pressure at the first nephrologist consultation.

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5. Fig. 4. Systolic blood pressure dynamics during pregnancy in women with CKD.

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6. Fig. 5. Dynamics of serum creatinine level in women with CKD.

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7. Fig. 6. Delivery time at different stages of CKD.

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8. Fig. 7. Birth weight of children in patients with different stages of CKD.

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