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Is renal hyperfiltration protective in chronic kidney disease‐stage 1 pregnancies? A step forward unravelling the mystery of the effect of stage 1 chronic kidney disease on pregnancy outcomes
Author(s) -
Piccoli Giorgina Barbara,
Attini Rossella,
Vigotti Federica Neve,
Parisi Silvia,
Fassio Federica,
Pagano Arianna,
Biolcati Marilisa,
Giuffrida Domenica,
Rolfo Alessandro,
Todros Tullia
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12372
Subject(s) - medicine , kidney disease , pregnancy , renal function , obstetrics , glomerular hyperfiltration , univariate analysis , odds ratio , gestational age , body mass index , gestational diabetes , birth weight , prospective cohort study , gestation , kidney , diabetic nephropathy , multivariate analysis , genetics , biology
Background The correlation between advanced or proteinuric chronic kidney disease ( CKD ) and adverse pregnancy outcomes is intuitive, although how early CKD affects pregnancy remains unknown. Glomerular hyperfiltration is a physiological response to pregnancy, correlated with outcomes in hypertension or collagen diseases. The aim of the study was to correlate first trimester hyperfiltration with pregnancy outcomes in stage 1 CKD patients. Methods A historical prospective study was conducted on the database of our Unit, gathering all pregnant CKD patients referred since 1 J anuary 2000. From 383 pregnancies referred in 2000–2013, 75 patients were selected (stage 1 CKD , referred within the 14th gestational week, singleton deliveries, absence of diabetes, hypertension or nephrotic proteinuria at referral, body mass index [ BMI ] < 30); 267 ‘low‐risk’ pregnancies, followed in the same setting, served as controls. Glomerular filtration rate ( GFR ) was assessed by C hronic K idney D isease E pidemiology C ollaboration ( CKD ‐ EPI ) and dichotomized at 120 mL/min. The odds for C aesarean section, prematurity, need for N eonatal I ntensive C are U nit ( NICU ) were assessed by univariate analysis and logistic regression. Results Risk for adverse pregnancy outcomes was not affected by hyperfiltration (univariate OR GFR ≥ 120 mL/min: Caesarean section 1.30 (0.46–3.65); preterm delivery: 0.84 (0.25–2.80)). In contrast, even in these cases with normal kidney function, stage 1 CKD was associated with prematurity (17.3% vs 4.9% P = 0.001), lower birth weight (3027 ± 586 versus 3268 ± 500 P < 0.001) need for NICU (12% vs 1.1% P < 0.001). In the multivariate analysis, the risks were significantly increased by proteinuria and maternal age but not by GFR . Conclusions In pregnant Stage 1 CKD patients, hyperfiltration was not associated with maternal‐foetal outcomes, thus suggesting a need to focus attention on qualitative factors, eventually enhanced by age, as vascular stiffness, endothelial damage or oxidative stress.