#3782 Pregnancy and kidney outcomes for individuals with rare kidney diseases

Résumé fourni par la source

Abstract Background and Aims For many women with different kidney diseases considering pregnancy there are insufficient data to inform decision making. High quality data could lead to tailored pre-pregnancy counselling and enhanced patient-centred decision making. In 2010 the UK Kidney Association (UKKA) launched a strategy for rare kidney disorders, which included establishing the National Registry of Rare Kidney Diseases (RaDaR) (>30,000 patients in 29 disease categories) with linkage to hospital laboratories and the UK Renal Registry (UKRR) for validated kidney replacement therapy (KRT) initiation and death. 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 with rare kidney disease in the UK using linked population data from RaDaR, UKRR, and HES. Method NHS number, ethnicity, kidney disease aetiology, date of diagnosis, date of birth, death, available laboratory data (serum creatinine and proteinuria) for women aged 15–50 years were extracted from RaDaR and 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 weight <3rd centile. Follow-up time was calculated as time from between date of delivery until end of 2022 or death, whichever occurred first. Descriptive data were reported according to distribution. Ethical approval was provided by NHS South-West-Central Bristol Research Ethics Committee (REC) (14/SW/1088), London- Bloomsbury REC (20/LO/029), UKRR CAG and UKRR operational committee. Results 3793 pregnancies of individuals with different kidney diseases were identified, including: Autosomal Dominant Polycystic Kidney Disease (ADPKD), Alport syndrome (AS), IgA nephropathy, Membranous Nephropathy (MN), and Membranoproliferative Glomerulonephritis (MPGN). Baseline demographics and pregnancy outcomes for ADPKD, AS, IgA nephropathy, MPGN and MN reported in Table 1 and Table 2. Maternal age and parity were comparable between these groups. The MN group had a higher proportion of pregnancies born to individuals of a non-white ethnicity and had a greater proportion of pre-existing diabetes. Live birth rates were high across all groups. Preterm births (<37 weeks) occurred in 59.3% (35/59) of pregnancies of individuals with MPGN, compared to 51.2% (22/43) of MN, 39.7% (71/179) IgA nephropathy, 27.5% (47/171) of AS and 17.1% (196/1656) of ADPKD. Conclusion This extensive data linkage study provides invaluable data to informing pregnancy choices for individuals with different kidney diseases, including time to kidney failure. Further exploration according to disease severity is planned. More data are needed to understand impact of disease severity on maternal and neonatal outcomes as well as differences in the latter between rare kidney diseases and to further explore the impact of pre-pregnancy optimisation on maternal and neonatal outcomes.

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