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Kidney function, blood pressure and proteinuria were associated with pregnancy outcomes of pregnant women with chronic kidney disease: a single-center, retrospective study in the Asian population

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Abstract

Background

Studies among pregnant Asian women with chronic kidney disease (CKD) have not been widely performed; therefore, clinical criteria for these patients have not been well established.

Methods

We conducted a retrospective study among pregnant women with CKD who received prenatal care at our institution for 8 consecutive years. Primary outcome was the development of severe adverse events (SAEs). We analyzed correlations between primary outcome and CKD parameters [age, body mass index (BMI), estimated glomerular filtration rate (eGFR), urinary protein–creatinine ratio (UP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and not normal blood pressure (non-NBP)] at the time of referral. Secondary outcomes were low birth weight (LBW), preterm delivery (PreD), and small for gestational age (SGA). We divided into two categories, CKD stage G1, and G2 or higher according to eGFR, and proteinuria negative and proteinuria positive according to UP, respectively.

Results

We observed 89 pregnancies. SAE was observed in 28 pregnancies. In live birth cases, there were 28 PreD, 28 LBW and 13 SGA. Major SAEs included preeclampsia, superimposed preeclampsia, unscheduled cesarean section, neonatal intensive care unit admission, and fetal death. Stepwise logistic regression analysis selected eGFR (OR = 0.847, p = 0.026), SBP (OR = 1.897, p = 0.006) and proteinuria positive (OR = 2.96, p = 0.046) as the significant predictors of SAEs. There were no significant differences among the baseline characteristics stratified by SGA.

Conclusions

This is the first study to report pregnancy outcomes among Japanese non-disease-oriented patients with CKD. In Asians, especially in the Japanese population, kidney function, blood pressure and proteinuria might affect pregnancy outcomes.

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Acknowledgements

We would like to acknowledge the staff of the medical record services for their contribution in providing the old medical records for the collection of data. The data of this study were preliminary presented at the American Society of Nephrology Congress, Kidney Week 2018, in San Diego, California, USA, October 23–28. Also, we would like to thank Editage (http://www.editage.jp) for English language editing.

Funding

There was no research funding for this study.

Author information

Authors and Affiliations

  1. Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Satoshi Kumakura, Koji Okamoto, Saeko Takeuchi, Mai Yoshida, Tasuku Nagasawa, Hiroshi Sato, Sadayoshi Ito, Hideo Harigae & Mariko Miyazaki

  2. Division of Blood Purification, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Satoshi Kumakura, Emi Fujikura & Mariko Miyazaki

  3. Department of Nephrology, Ishinomaki Red-Cross Hospital, 71 Hebita-Aza-Nishinomichishita, Ishinomaki, Miyagi, 986-8255, Japan

    Takashi Nakamichi

  4. Department of Internal Medicine, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Aoba-ku, Sendai, Miyagi, 980-8502, Japan

    Tae Yamamoto

  5. Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Masatoshi Saito

  6. Department of Pediatrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Takushi Hanita

  7. Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8536, Japan

    Michihiro Satoh

  8. Department of Internal Medicine, JR Sendai Hospital, 1-1-5 Itsutsubashi, Aoba-ku, Sendai, Miyagi, 980-0022, Japan

    Hiroshi Sato

  9. Department of Medicine, Katta General Hospital, 36 Fukuokakuramoto-Aza-Shimookibara, Shiroishi, Miyagi, 989-0231, Japan

    Sadayoshi Ito

Authors
  1. Satoshi Kumakura
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  2. Koji Okamoto
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  3. Saeko Takeuchi
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  4. Mai Yoshida
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  5. Takashi Nakamichi
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  6. Tasuku Nagasawa
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  7. Emi Fujikura
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  8. Tae Yamamoto
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  9. Masatoshi Saito
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  10. Takushi Hanita
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  11. Michihiro Satoh
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  12. Hiroshi Sato
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  13. Sadayoshi Ito
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  14. Hideo Harigae
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  15. Mariko Miyazaki
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Contributions

SK, TN, TN, KO, TH, MS and MM were involved in design of the work and interpretation of the data. SK, MS, KO analyzed the data. All authors were involved in drafting or revising the manuscript and approved the final version.

Corresponding author

Correspondence to Mariko Miyazaki.

Ethics declarations

Conflict of interest

All of the authors have declared no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval no. 2017-1-934 at Ethics committee of Tohoku University School of Medicine) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

According to Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects, informed consent was not obtained from participants because all data were anonymized. Otherwise, we made a piece of public information which states including and handling the exiting information and giving them opportunities to withdraw from the research.

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Kumakura, S., Okamoto, K., Takeuchi, S. et al. Kidney function, blood pressure and proteinuria were associated with pregnancy outcomes of pregnant women with chronic kidney disease: a single-center, retrospective study in the Asian population. Clin Exp Nephrol 24, 547–556 (2020). https://doi.org/10.1007/s10157-020-01865-0

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  • DOI: https://doi.org/10.1007/s10157-020-01865-0

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