Pregnancy and kidney disease

Delegates at the Irish Nephrology Society Annual Scientific Meeting 2024 heard from Dr Blathnaid O’Connell, Renal Specialty Registrar, Beaumont Hospital, Dublin, who shared updates in obstetric nephrology from the European Renal Association Annual Conference, which she attended in Stockholm, Sweden, from 23-26 May, 2024. “Just over half of nephrologists felt confident counselling women with CKD [chronic kidney disease] on pregnancy,” she presented recent research, “and less than half of nephrologists felt comfortable in counselling women on foetal complications depending on CKD stage.”

Referencing a study that was published in Kidney International Reports last year, Dr O’Connell also noted that 60 per cent of women with CKD had to initiate conversations about pregnancy with their nephrologists themselves, and one in six were already pregnant at the time of initiation. “Just over half felt in control of their pregnancy,” she added.

Dr O’Connell went on to look at outcomes according to CKD stage, and noted the higher the stage of CKD, the higher the risk of complications, particularly in stages 4 and 5. “The worse the creatinine is pre-conception, the more likely the GFR [glomerular filtration rate] is to deteriorate six months post-partum,” she said. Regarding neonatal outcomes as per CKD stage, delegates heard that “from stage 3 onwards, there is an increased rate of preterm birth, reduced birth weight, and NICU [neonatal intensive care] admission, and again, it’s worse in stage 4 and 5”.

Dr O’Connell moved on to look at transplant data, noting acute rejection rates in pregnancy “are very reassuring for our cohort”. She also cited research examining outcomes up to 10 years post-pregnancy in transplanted women, and “again the results are very reassuring”, with no increased tendency towards graft loss. Dr O’Connell then presented a graphic of maternal and foetal complications as per CKD stage in dialysis versus transplant, and suggested counselling women to wait until they are post-transplant if they are happy to do so based on the positive outcomes. The talk concluded with an overview of the management of pregnant women with CKD, including those on dialysis.