Pre-Eclampsia and Chronic Kidney Disease

Pregnant women with chronic kidney disease (CKD) are at increased risk for pre-eclampsia, yet there are few data available on the features of pre-eclampsia in that patient population. Natalia Kozlovskaya and colleagues conducted a study to examine the incidence and characteristics of pre-eclampsia in patients with CKD.

Results of the study were reported during a presentation at the European Renal Association 59th Congress. The presentation was titled Pre-Eclampsia in Patients With Chronic Kidney Disease (CKD).

The retrospective analysis included 60 case histories of pregnant women with CKD stages 1-4 (27 of those had CKD stage 3a-4), who were followed in a dedicated center from 2018 to 2021. Ten of the women with CKD stage 3a-4 developed pre-eclampsia; the researchers examined the course of the pregnancies of those 10 women.

At the first visit to the center, indicators of creatinine, proteinuria, and blood pressure were measured; the markers were measured again at the time of pre-eclampsia. In six women with a known creatinine value prior to pregnancy and who had a 10% decrease in creatinine concentration from the pre-pregnancy value, the physiological response of the kidneys to pregnancy was assessed.

Among the patients with pre-eclampsia and advanced  CKD, mean age was 32 years. The most common cause of CKD was glomerulonephritis (6 patients); other causes were tubulointerstitial nephritis (1 patient), diabetic nephropathy (1 patient), atypical hemolytic uremic syndrome (1 patient), and antiphospholipid-associated nephropathy (1 patient). Three of the 10 patients had complicated obstetric history. Mean term of gestation at the time of the first visit to a nephrologist was 15.6 weeks.

Mean serum creatinine at the first measurement during pregnancy was 157 mmol/L. Physiological response of the kidneys to pregnancy was noted in only one of the six women with pre-pregnancy data; mean proteinuria was 1.2 g/L.

Three patients had arterial hypertension; only one women received antihypertensive therapy prior to pregnancy. Mean blood pressure at the first visit was 131/84 mm Hg. In six women, aspirin for the prevention of pre-eclampsia was prescribed; in the other four patients, aspirin was either not prescribed or added to therapy after 12 weeks of pregnancy.

Early pre-eclampsia (prior to 34 weeks of gestation) developed in seven patients; mean term for the development of pre-eclampsia was 31.3 weeks. Mean blood pressure at the time of pre-eclampsia was 142/90 mm Hg. Six women developed acute kidney injury. Mean delivery term was 32.4 weeks of gestation; all infants were alive and viable with a mean weight of 1514 g.

In summary, the researchers said, “According to our data, the main features of pre-eclampsia in patients with advanced CKD are its early onset (up to 34 weeks), severe course with AKI in 60% of cases, with relatively low blood pressure values.”

Source: Kozlovskaya N, Alekseeva M, Demyanova K, Korotchaeva Y, Chegodaeva A, Apresyan S. Pre-eclampsia in patients with chronic kidney disease (CKD). Abstract of a presentation at the European Renal Association 59th Congress (M0080), Paris, France, May 19-22, 2022.