#2746 Pregnancy and kidney outcomes for individuals receiving kidney replacement therapy

Résumé fourni par la source

Abstract Background and Aims Pregnancy after kidney transplant or while receiving dialysis remains uncommon. Current cohorts are often single centre with inconsistent outcome reporting. High quality data could lead to improved pre-pregnancy counselling and enhanced patient-centred decision making. The UK Renal Registry (UKRR) collates data from kidney centres and hospital laboratories to improve the care of patients with kidney disease in the UK. Hospital Episode Statistics (HES) data contain admissions, outpatient appointments and historical accident and emergency attendances at NHS hospitals. We aimed to describe pregnancy outcomes for women receiving kidney replacement therapy (KRT) in the United Kingdom using linked population data from UKRR and HES. Method NHS number, ethnicity, cause of kidney failure, date of birth, death, available laboratory data (serum creatinine and proteinuria), date of commencing KRT and KRT modality of all women age 15–50 years were extracted from UKRR (1997–2022) and linked with HES data (1997/98 to 2021/22) by NHS Digital to create a dataset of women with recorded deliveries. Extracted ICD-10 coded comorbidities including diabetes and hypertension, and pregnancy outcomes including parity, mode of delivery, pregnancy induced hypertension, live birth, gestational age and birthweight were reported and birth centiles calculated. Small for gestational age (SGA) was defined as birthweight <3rd centile. Descriptive data were reported according to distribution. Ethical approval was provided by NHS South-West-Central Bristol Research Ethics Committee (14/SW/1088), London Bloomsbury Research Ethics Committee (20/LO/029), UKRR CAG and UKRR operational committee. Results 1,215 pregnancies of individuals receiving KRT at conception were identified of whom: 1134 (93.3%) were kidney transplant recipients, 72 (5.9%) were on haemodialysis (HD) and 9 (0.7%) on peritoneal dialysis (PD). Maternal age, parity, preexisting hypertension and diabetes rates were comparable between HD and transplant groups (Table 1 and 2). Low numbers of PD pregnancies limited comparison statistics. There was a higher proportion of individuals of minority ethnicities in those receiving HD 23/72 (31.9%) compared to transplant 193/1134 (17.1%, p< 0.0001). Transplanted individuals had a higher duration of KRT median duration prior to pregnancy of 7.8 years (IQR 4.8, 12.4) compared to HD 3.0 (IQR 1.5, 7.9) and PD 2.2 (1.8, 3.1). The most common primary renal disease was glomerulonephritis (including lupus) seen in 32/72 (44.4%) HD, and 427/1134 (37.7%) transplant pregnancies. Livebirth rates were high 45/47 (95.7%) HD, and 910/927 (98.2%) transplant but with high rates of caesarean births; 36/72 (50.0%) in HD and 755/1134 (66.6%) in transplant. Gestational age was lower in those receiving HD compared to PD and transplant (median 31 v 35 and 36 weeks, p = 0.047 from Kruskal–Wallis test) with higher rates of early preterm birth (<34 weeks) in HD 27/45 (60.0%) v 217/828 (26.2%) in transplant (p < 0.0001) and SGA <3rd 5/44 (11.4%) HD v 46/785 (5.9%) Transplant (p = 0.14). Conclusion This large linkage study provides invaluable data describing pregnancy outcomes for individuals receiving KRT. Livebirth rates were high in those on dialysis or with kidney transplant, but both KRT modalities have higher rates of pregnancy induced hypertension and caesarean birth than the general obstetric cohort in the UK. Pregnancy on dialysis was associated with earlier gestational age at delivery and high rates of SGA compared to transplant recipients although some of this difference may reflect increasing dialysis intensification in pregnancy in recent years. Prospective data are needed to understand the drivers of early delivery especially in the dialysis population as well as the longer-term impact on the children.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.