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Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease

Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, maki...

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Autores principales: Sorohan, Bogdan Marian, Andronesi, Andreea, Ismail, Gener, Jurubita, Roxana, Obrisca, Bogdan, Baston, Cătălin, Harza, Mihai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279325/
https://www.ncbi.nlm.nih.gov/pubmed/32349458
http://dx.doi.org/10.3390/medicina56050213
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author Sorohan, Bogdan Marian
Andronesi, Andreea
Ismail, Gener
Jurubita, Roxana
Obrisca, Bogdan
Baston, Cătălin
Harza, Mihai
author_facet Sorohan, Bogdan Marian
Andronesi, Andreea
Ismail, Gener
Jurubita, Roxana
Obrisca, Bogdan
Baston, Cătălin
Harza, Mihai
author_sort Sorohan, Bogdan Marian
collection PubMed
description Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, making differential diagnosis difficult. Objective: The aim of this study was to evaluate the incidence and the clinical-biological predictors of preeclampsia in pregnant women with CKD. Material and Methods: We retrospectively analyzed 34 pregnant women with pre-existing CKD admitted to our department between 2008 and 2017. Results: Among the 34 patients, 19 (55.8%) developed PE and the mean time of occurrence was 31.26 ± 2.68 weeks of gestation. The median value of 24-h proteinuria at referral was 0.87 g/day (interquartile range 0.42–1.50) and 47.1% of patients had proteinuria of ≥1 g/day. Patients with PE tended to be more hypertensive, with a more decreased renal function at referral and had significantly higher proteinuria (1.30 vs. 0.63 g/day, p = 0.02). Cox multivariate analysis revealed that proteinuria ≥1 g/day at referral and pre-existing hypertension were independently associated with PE (adjusted hazard ratio = 4.10, 95% confidence interval: 1.52–11.02, p = 0.005, adjusted hazard ratio = 2.62, 95% confidence interval: 1.01–6.77, p = 0.04, respectively). The cumulative risk of PE was significantly higher in pregnant women with proteinuria ≥1 g/day at referral (log-rank, p = 0.003). Proteinuria ≥ 1 g/day at referral and pre-exiting hypertension predicted PE development with accuracies of 73.5% and 64.7%, respectively. Conclusions: Pregnant patients with pre-existing CKD are at high risk of developing preeclampsia, while proteinuria ≥ 1 g/day at referral and pre-existing hypertension were independent predictors of superimposed preeclampsia.
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spelling pubmed-72793252020-06-17 Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease Sorohan, Bogdan Marian Andronesi, Andreea Ismail, Gener Jurubita, Roxana Obrisca, Bogdan Baston, Cătălin Harza, Mihai Medicina (Kaunas) Article Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, making differential diagnosis difficult. Objective: The aim of this study was to evaluate the incidence and the clinical-biological predictors of preeclampsia in pregnant women with CKD. Material and Methods: We retrospectively analyzed 34 pregnant women with pre-existing CKD admitted to our department between 2008 and 2017. Results: Among the 34 patients, 19 (55.8%) developed PE and the mean time of occurrence was 31.26 ± 2.68 weeks of gestation. The median value of 24-h proteinuria at referral was 0.87 g/day (interquartile range 0.42–1.50) and 47.1% of patients had proteinuria of ≥1 g/day. Patients with PE tended to be more hypertensive, with a more decreased renal function at referral and had significantly higher proteinuria (1.30 vs. 0.63 g/day, p = 0.02). Cox multivariate analysis revealed that proteinuria ≥1 g/day at referral and pre-existing hypertension were independently associated with PE (adjusted hazard ratio = 4.10, 95% confidence interval: 1.52–11.02, p = 0.005, adjusted hazard ratio = 2.62, 95% confidence interval: 1.01–6.77, p = 0.04, respectively). The cumulative risk of PE was significantly higher in pregnant women with proteinuria ≥1 g/day at referral (log-rank, p = 0.003). Proteinuria ≥ 1 g/day at referral and pre-exiting hypertension predicted PE development with accuracies of 73.5% and 64.7%, respectively. Conclusions: Pregnant patients with pre-existing CKD are at high risk of developing preeclampsia, while proteinuria ≥ 1 g/day at referral and pre-existing hypertension were independent predictors of superimposed preeclampsia. MDPI 2020-04-27 /pmc/articles/PMC7279325/ /pubmed/32349458 http://dx.doi.org/10.3390/medicina56050213 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sorohan, Bogdan Marian
Andronesi, Andreea
Ismail, Gener
Jurubita, Roxana
Obrisca, Bogdan
Baston, Cătălin
Harza, Mihai
Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease
title Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease
title_full Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease
title_fullStr Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease
title_full_unstemmed Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease
title_short Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease
title_sort clinical predictors of preeclampsia in pregnant women with chronic kidney disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279325/
https://www.ncbi.nlm.nih.gov/pubmed/32349458
http://dx.doi.org/10.3390/medicina56050213
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