Chronic kidney disease in pregnancy: Maternal and fetal outcomes and progression of kidney disease

Davidson, Natalie L; Wolski, Penny; Callaway, Leonie K.; Barrett, Helen L.; Fagermo, Narelle; Lust, Karin; Shakhovskoy, Rebekah

doi:10.1177/1753495x15576461

Cited by 12 publications

(13 citation statements)

References 25 publications

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“…In addition, arbitrary cut points were used in these studies to define prepregnancy kidney dysfunction, and there was no accounting for important confounders. 5,[8][9][10][11][12][13][14] In an effort to overcome the aforementioned limitations, we completed a large cohort study in a setting where prenatal and obstetric care is covered under a provincial health insurance plan. Using population-derived cut points for prepregnancy serum creatinine to define kidney dysfunction, we examined the risk of preterm birth and other related outcomes.…”

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confidence: 99%

Prepregnancy renal function and risk of preterm birth and related outcomes

Harel

Park

McArthur

et al. 2020

CMAJ

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Prepregnancy kidney dysfunction may perturb the normal physiologic adaptations of pregnancy, predisposing a woman and her fetus to adversity, at least partly mediated by placental and endothelial dysfunction. 1 Complications such as preeclampsia 2 and poor fetal growth 3 may necessitate provider-initiated preterm birth. Preterm birth of any form before 37 weeks' gestation occurs in 6% to 11% of viable pregnancies and is the leading cause of infant death. 4 Prepregnancy kidney dysfunction has been associated with preterm birth. [5][6][7] Prior studies of the relation between prepregnancy kidney dysfunction and preterm birth were primarily case series and thus had inadequate statistical power to differentiate between the outcomes of spontaneous versus providerinitiated preterm birth. In addition, arbitrary cut points were used in these studies to define prepregnancy kidney dysfunction, and there was no accounting for important confounders. 5,[8][9][10][11][12][13][14] In an effort to overcome the aforementioned limitations, we completed a large cohort study in a setting where prenatal and obstetric care is covered under a provincial health insurance plan. Using population-derived cut points for prepregnancy serum creatinine to define kidney dysfunction, we examined the risk of preterm birth and other related outcomes. Methods Study design and data sourcesIn this population-based cohort study, we considered all live births and stillbirths that occurred in hospital in Ontario, Canada, from April 2007 to October 2016. Obstetric care is covered for Ontario residents through the Ontario Health Insurance Plan, and nearly all women undergo ultrasonography during the first or second trimester to enable accurate dating of the pregnancy.

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confidence: 99%

Prepregnancy renal function and risk of preterm birth and related outcomes

Harel

Park

McArthur

et al. 2020

CMAJ

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“…Important questions remain unanswered, including the ideal timing and optimal immunosuppressive regimen as well as how to identify which women are at greatest risk of complications. While fertility has been shown to be negatively affected by CKD, the safety and efficacy of reproductive technology use in women with CKD remains unclear (Cabiddu et al, 2018;Davidson et al, 2015;Davison & Lindheimer, 2011;Norman et al, 2015;Warzecha et al, 2018). Likewise, the safety and efficacy of various forms of contraception is not well-studied in women with CKD (Attini et al, 2020;Davison, 2007), with the optimal method still undefined.…”

Section: Ckd and Reproductive Counsellingmentioning

confidence: 99%

Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease

2021

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The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. KeywordsChronic kidney disease • Dialysis • End stage renal disease • Kidney transplantation • Pregnancy • Reproduction • Reproductive counseling • Shared decision making Women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant, receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with

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“…Elucidating the etiology of AKI is of the utmost importance in pregnancy because once the diagnosis is made the cure can be promptly initiated. The longer the duration of AKI, the higher the reduction of nephron mass, and the higher the chances of developing CKD later in life [69].…”

Section: Challenges In Diagnosis Of Pr-akimentioning

confidence: 99%

The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective

Vinturache

Popoola

Watt-Coote

2019

JCM

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Pregnancy-related acute kidney injury (PR-AKI) is a heterogeneous disorder with multiple aetiologies that can occur at any time throughout pregnancy and the post-partum period. PR-AKI is an important obstetric complication that is associated with significant maternal and foetal morbidity and mortality. Although there has been an overall decline in the incidence of PR-AKI worldwide, a recent shift in the occurrence of this disease has been reported. Following improvements in obstetric care, PR-AKI incidence has been reduced in developing countries, whereas an increase in PR-AKI incidence has been reported in developed countries. Awareness of the physiological adaptations of the renal system is essential for the diagnosis and management of kidney impairment in pregnancy. In this review we scrutinize the factors that have contributed to the changing epidemiology of PR-AKI and discuss challenges in the diagnosis and management of acute kidney injury (AKI) in pregnancy from an obstetrics perspective. Thereafter we provide brief discussions on the diagnostic approach of certain PR-AKI aetiologies and summarize key therapeutic measures.

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Chronic kidney disease in pregnancy: Maternal and fetal outcomes and progression of kidney disease

Abstract: Chronic kidney disease of all stages is a risk factor for adverse pregnancy outcomes. In a tertiary institution however, there is a high rate of successful pregnancy (84%).

Cited by 12 publications

References 25 publications

Prepregnancy renal function and risk of preterm birth and related outcomes

Prepregnancy renal function and risk of preterm birth and related outcomes

Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease

The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective

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