Abstract
Aim: The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD).
Methods: We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes.
Results: We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08–0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09–0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23–0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92–123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93–1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17–0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients.
Conclusion: Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis.
Correction Note
Correction added after online publication February 23, 2015: Results within the abstract: “Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 0.31 (95% CI 0.93–1.85)].” The OR in the sentence should be OR 1.31 (95% 0.93–1.85).
References
[1] Bili E, Tsolakidis D, Stangou S, Tarlatzis B. Pregnancy management and outcome in women with chronic kidney disease. Hippokratia. 2013;17:163–8.Search in Google Scholar
[2] Nadeau-Fredette AC, Hladunewich M, Hui D, Keunen J, Chan CT. End-stage renal disease and pregnancy. Adv Chronic Kidney Dis. 2013;20:246–52.10.1053/j.ackd.2013.01.010Search in Google Scholar PubMed
[3] Zegarac Z, Duic Z, Stasenko S, Fenzl V, Zmijanac-Partl J, Knotek M. Successful pregnancy and delivery after kidney transplantation. Med Arch. 2012;66:278–80.10.5455/medarh.2012.66.278-280Search in Google Scholar PubMed
[4] Drolet S, Maclean AR, Myers RP, Shaheen AA, Dixon E, Donald Buie W. Morbidity and mortality following colorectal surgery in patients with end-stage renal failure: a population-based study. Dis Colon Rectum. 2010;53:1508–16.10.1007/DCR.0b013e3181e8fc8eSearch in Google Scholar PubMed
[5] Navaneethan U, Parasa S, Venkatesh PG, Shen B. Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis. Int J Colorectal Dis. 2012;27:811–6.10.1007/s00384-011-1400-8Search in Google Scholar PubMed
[6] Sakhuja A, Schold JD, Kumar G, Katzan I, Navaneethan SD. Nontraumatic subarachnoid hemorrhage in maintenance dialysis hospitalizations: trends and outcomes. Stroke. 2014;45:71–6.10.1161/STROKEAHA.113.003012Search in Google Scholar PubMed
[7] Toma H, Tanabe K, Tokumoto T, Kobayashi C, Yagisawa T. Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant. 1999;14:1511–6.10.1093/ndt/14.6.1511Search in Google Scholar PubMed
[8] Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, et al. Colorectal surgery in kidney transplant recipients: a decade of trends and outcomes in the United States. Am Surg. 2013;79:1026–33.10.1177/000313481307901015Search in Google Scholar
[9] Chen SY, Lee YC, Alas V, Greene M, Brixner D. Outcomes associated with nonconcordance to national kidney foundation guideline recommendations for oral antidiabetic drug treatments in patients with concomitant type 2 diabetes and chronic kidney disease. Endocr Pract. 2014;20:221–31.10.4158/EP13269.ORSearch in Google Scholar PubMed
[10] Kumar G, Sakhuja A, Taneja A, Majumdar T, Patel J, Whittle J, et al., Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol. 2012;7:1584–90.10.2215/CJN.00250112Search in Google Scholar PubMed PubMed Central
[11] Aggarwal RS, Mishra VV, Jasani AF, Gumber M. Acute renal failure in pregnancy: our experience. Saudi J Kidney Dis Transpl. 2014;25:450–5.10.4103/1319-2442.128621Search in Google Scholar PubMed
[12] Van Hook JW. Acute kidney injury during pregnancy. Clin Obstet Gynecol. 2014;57:851–61.10.1097/GRF.0000000000000069Search in Google Scholar
[13] Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, et al. Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India. Saudi J Kidney Dis Transpl. 2014;25:906–11.10.4103/1319-2442.135215Search in Google Scholar
[14] Fischer MJ, Lehnerz SD, Hebert JR, Parikh CR. Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy. Am J Kidney Dis. 2004;43:415–23.10.1053/j.ajkd.2003.10.041Search in Google Scholar
[15] Tikkanen M, Luukkaala T, Gissler M, Ritvanen A, Ylikorkala O, Paavonen J, et al. Decreasing perinatal mortality in placental abruption. Acta Obstet Gynecol Scand. 2013;92:298–305.10.1111/aogs.12030Search in Google Scholar
[16] Bick D. Born too soon: the global issue of preterm birth. Midwifery. 2012;28:341–2.10.1016/j.midw.2012.06.010Search in Google Scholar
[17] Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108:1005–16.10.1097/01.AOG.0000239439.04364.9aSearch in Google Scholar
[18] Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90: 140–9.10.1111/j.1600-0412.2010.01030.xSearch in Google Scholar
[19] Ananth CV, Savitz DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol. 1996;88:309–18.10.1016/0029-7844(96)00088-9Search in Google Scholar
[20] Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med. 2003;115:291–7.10.1016/S0002-9343(03)00366-8Search in Google Scholar
[21] Scott LL, Ramin SM, Richey M, Hanson J, Gilstrap LC 3rd. Erythropoietin use in pregnancy: two cases and a review of the literature. Am J Perinatol. 1995;12:22–4.10.1097/00006254-199508000-00002Search in Google Scholar
[22] Fried W. Erythropoietin and erythropoiesis. Exp Hematol. 2009;37:1007–15.10.1016/j.exphem.2009.05.010Search in Google Scholar
[23] Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol. 2003;21:437–40.10.1002/uog.103Search in Google Scholar
[24] Humar A, Matas AJ. Surgical complications after kidney transplantation. Semin Dial. 2005;18:505–10.10.1111/j.1525-139X.2005.00097.xSearch in Google Scholar
[25] Josephson MA, McKay DB. Women and transplantation: fertility, sexuality, pregnancy, contraception. Adv Chronic Kidney Dis. 2013;20:433–40.10.1053/j.ackd.2013.06.005Search in Google Scholar
[26] Likis FE, Sathe NA, Carnahan R, McPheeters ML. A systematic review of validated methods to capture stillbirth and spontaneous abortion using administrative or claims data. Vaccine. 2013;31:K74–82.10.1016/j.vaccine.2013.03.076Search in Google Scholar
[27] Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: where? when? why? how to make the data count? Lancet. 2011;377:1448–63.10.1016/S0140-6736(10)62187-3Search in Google Scholar
[28] Vergani P, Cozzolino S, Pozzi E, Cuttin MS, Greco M, Ornaghi S, et al. Identifying the causes of stillbirth: a comparison of four classification systems. Am J Obstet Gynecol. 2008;199:319.e1–4.10.1016/j.ajog.2008.06.098Search in Google Scholar PubMed
[29] Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol. 2005;193:1923–35.10.1016/j.ajog.2005.03.074Search in Google Scholar PubMed
[30] McClure EM, Nalubamba-Phiri M, Goldenberg RL. Stillbirth in developing countries. Int J Gynaecol Obstet. 2006;94:82–90.10.1016/j.ijgo.2006.03.023Search in Google Scholar PubMed
[31] Hamilton BE, Miniño AM, Martin JA, Kochanek KD, Strobino DM, Guyer B. Annual summary of vital statistics: 2005. Pediatrics. 2007;119:345–60.10.1542/peds.2006-3226Search in Google Scholar PubMed
[32] Glorieux G, Vanholder R. New uremic toxins – which solutes should be removed? Contrib Nephrol. 2011;168:117–28.10.1159/000321750Search in Google Scholar
[33] Antonelou MH, Georgatzakou HT, Tzounakas VL, Velentzas AD, Kokkalis AC, Kriebardis AG, et al. Blood modifications associated with end stage renal disease duration, progression and cardiovascular mortality: a 3-year follow-up pilot study. J Proteomics. 2014;101:88–101.10.1016/j.jprot.2014.02.009Search in Google Scholar
[34] Albu AR, Anca AF, Horhoianu VV, Horhoianu IA. Predictive factors for intrauterine growth restriction. J Med Life. 2014;7: 165–71.Search in Google Scholar
[35] Nevis IF, Reitsma A, Dominic A, McDonald S, Thabane L, Akl EA, et al. Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol. 2011;6: 2587–98.10.2215/CJN.10841210Search in Google Scholar
[36] Hendrix N, Berghella V. Non-placental causes of intrauterine growth restriction. Semin Perinatol. 2008;32:161–5.10.1053/j.semperi.2008.02.004Search in Google Scholar
[37] Redline RW. Placental pathology: a systematic approach with clinical correlations. Placenta. 2008;29:S86–91.10.1016/j.placenta.2007.09.003Search in Google Scholar
[38] Berghella V. Prevention of recurrent fetal growth restriction. Obstet Gynecol. 2007;110:904–12.10.1097/01.AOG.0000267203.55718.aaSearch in Google Scholar
[39] Hayden PS, Iyengar SK, Schelling JR, Sedor JR. Kidney disease, genotype and the pathogenesis of vasculopathy. Curr Opin Nephrol Hypertens. 2003;12:71–8.10.1097/00041552-200301000-00012Search in Google Scholar
[40] Sankaran S, Kyle PM. Aetiology and pathogenesis of IUGR. Best Pract Res Clin Obstet Gynaecol. 2009;23:765–77.10.1016/j.bpobgyn.2009.05.003Search in Google Scholar
[41] Asamiya Y, Otsubo S, Matsuda Y, Kimata N, Kikuchi K, Miwa N, et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int. 2009;75:1217–22.10.1038/ki.2009.48Search in Google Scholar
[42] Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis. 1998;31:766–73.10.1016/S0272-6386(98)70044-7Search in Google Scholar
[43] Panaye M, Jolivot A, Lemoine S, Guebre-Egziabher F, Doret M, Morelon E, et al. [Pregnancies in hemodialysis and in patients with end-stage chronic kidney disease: epidemiology, management and prognosis] [Article in French]. Nephrol Ther. 2014;10:485–91.10.1016/j.nephro.2014.06.006Search in Google Scholar PubMed
[44] Tan LK, Kanagalingam D, Tan H-K, Choong H-L. Obstetric outcomes in women with end-stage renal failure requiring renal dialysis. Int J Gynaecol Obstet. 2006;94:17–22.10.1016/j.ijgo.2006.03.033Search in Google Scholar PubMed
[45] Jones DC, Hayslett JP, Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med. 1996;335:226–32.10.1056/NEJM199607253350402Search in Google Scholar PubMed
[46] Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, et al., Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis. 2007;49:753–62.10.1053/j.ajkd.2007.03.022Search in Google Scholar PubMed
[47] Lessan-Pezeshki M. Pregnancy after renal transplantation: points to consider. Nephrol Dial Transplant. 2002;17:703–7.10.1093/ndt/17.5.703Search in Google Scholar PubMed
[48] Edipidis K. Pregnancy in women with renal disease. Yes or no? Hippokratia. 2011;15:8–12.Search in Google Scholar
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2016 by De Gruyter
