Factors related to deterioration of renal function after singleton delivery in pregnant women with chronic kidney disease

Abstract

Objective: This study is designed to evaluate which factors would relate to deterioration of renal function (DRF) after delivery in pregnant women with chronic kidney disease (CKD). Materials and methods: This study included 156 singleton pregnancies of 139 women with CKD at our institution from 2001 to 2010. DRF was defined as the shift of CKD stage into another more severe stage. The relevant variables were compared between women who had DRF (n = 39) and the controls (n = 117). Results: The number of transplantation or dialysis cases after delivery was 5.8%. DRF occurred in 25% of the study patients. From a logistic regression model, the factors that influence DRF were the presence of glomerulonephritis [odds ratio (OR) 3.56, 95% confidence interval (CI) 1.18–10.81], significant proteinuria prior to pregnancy (≥3 g/d or 3+ more dipstick; OR 3.43, 95% CI 1.14–10.33), and treatment with antiplatelet agents (OR 0.30, 95% CI 0.09–0.94). Receiver-operating characteristic curve analysis confirmed that the estimated glomerular filtration rate (eGFR) of 75 mL/min/1.73 m2 or more before conception is not a risk factor for DRF after delivery (negative predictive value 0.788). Conclusion: This was the first report to reveal a clear cutoff value regarding DRF in pregnant woman with CKD. There is an almost 78% risk of developing DRF after delivery in patients showing eGFR of 75 mL/min/1.73 m2 or more before conception.

Keywords

• chronic kidney disease
• estimated glomerular filtration rate
• pregnancy
• receiver-operating characteristic curve analysis