Predictors of poor obstetric outcome among women with chronic kidney disease: A five-year observational study.

Abstract

Objective: To assess prospectively the maternal and fetal outcome among pregnant women with chronic kidney disease (CKD) compared to normal control group to find out predictors of poor obstetric outcome. Methods: A prospective observational study conducted on 490 pregnant women with CKD who were divided into two groups according to K-DOQI guidelines, group 1 (n=286, stage-1 CKD) and group 2 (n=204, stages 2-4 CKD) with a third group of normal pregnant women (n=200). Obstetric outcome was recorded. Univariate and multivariate regression analysis was used to assess the association between poor obstetric outcome and maternal risk factors. Results: Patients with CKD were more prone to experience poor maternal and fetal outcome compared to control group (p<0.001). Stage of CKD ≥ 2 (OR=2.33, CI= 1.26-3.96), duration of CKD ≥ 5 years (OR=0.69, CI=0.53-0.98), baseline creatinine 1.5-3 mg/dl (OR=2.14, CI=1.34-3.44), baseline creatinine >3 Mg/dL (OR=2.28, CI=1.17-4.05), pelvicalyceal dilatation on renal ultrasound (OR=1.49, CI=1.22-2.85), initial Hypertension (OR=4.11, CI=1.71-9.85), intake of more than two antihypertensive drugs (OR=1.75, CI=1.28-3.88), antenatal care visits<6 (OR=1.99, CI=1.45-2.76), initial proteinuria (OR= 2.23, CI=1.99-2.89), development of preeclampsia (OR=1.66, CI=1.11-3.21), the presence of prenatal anemia (OR=0.14, CI=0.02-0.25) and the presence of underlying systemic disease (OR=3.08, CI=2.04-4.65) were strong predictors of poor obstetric outcome in patients with CKD. Conclusions: Patients with CKD even those in the early stage suffered from poor maternal and fetal outcome. Many risk factors other than hypertension, proteinuria and underlying systemic disease were identified as predictors of poor obstetric outcome.