Pregnancy in CKD: whom should we follow and why?

Piccoli, Giorgina Barbara; Fassio, Federica; Attini, Rossella; Parisi, Silvia; Biolcati, Marilisa; Ferraresi, Martina; Pagano, Arianna; Daidola, Germana; Deagostini, Maria Chiara; Gaglioti, P.; Todros, Tullia

doi:10.1093/ndt/gfs302

Cited by 86 publications

(79 citation statements)

References 34 publications

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“…This study was conducted in the Maternal-Fetal Medicine Unit of the Sant'Anna University Hospital (150 beds for obstetric patients) in Turin, Italy, 36 and in the Nephrology Department of the Brotzu Hospital (30 beds for nephrology and transplantation, 25 beds in obstetrics) in Cagliari, Italy. These two settings have the broadest experience with CKD in pregnancy in Italy.…”

Section: Study Settings and Referral Criteriamentioning

confidence: 99%

“…In Turin, the outpatient unit dedicated to kidney diseases in pregnancy was established in 2000. 36 In Cagliari, a joint nephrology-obstetrics outpatient service has been active since 1989. Both units collected data prospectively.…”

Section: Study Settings and Referral Criteriamentioning

confidence: 99%

“…[36][37][38][39] Turin-1 and Turin-2 consist of low-risk singleton pregnancies referred in 1999-2007 and in 2011-2013, respectively. The Cagliari control cohort was selected from among the low-risk patients followedup by the obstetrics unit between 2009 and 2013 (random selection of 3 sample months per year).…”

Section: Patient and Control Populationsmentioning

confidence: 99%

“…35 eGFR was calculated on preconception data, when available within 3 months before conception (38% of the cases in Torino and 57% in Cagliari) or on data at first check-up in pregnancy, employing the Cockcroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration formulas; the latter was chosen on account of its wider use. 36,[40][41][42] After referral, creatinine clearance and proteinuria were assessed on 24-hour urine collection.…”

Section: Definitions and Main Clinical Indicationsmentioning

confidence: 99%

“…The diagnoses of CKD and of preeclampsia were classified as described elsewhere 36 ; systemic diseases included diabetic nephropathy, SLE, collagen diseases or vasculitides, and kidney transplantation.…”

Section: Definitions and Main Clinical Indicationsmentioning

confidence: 99%

See 4 more Smart Citations

Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

306

335

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CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (.1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P,0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

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Section: Study Settings and Referral Criteriamentioning

confidence: 99%

Section: Study Settings and Referral Criteriamentioning

confidence: 99%