Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com: What are the main findings of the study?

The main results of our study, in agree with the recent literature, can be summarized in two main points:

1. CKD is a risk factor in pregnancy in all stages. Also stage 1 CKD patients are at increased risk for adverse pregnancy outcomes, such as Caesarean section, preterm delivery and need for NICU (Neonatal Intensive Care Unit). The risk for adverse pregnancy related events increases along with the CKD stage.

2. Pregnancy is a important occasion for early diagnosis of CKD in stage 1 patients. In our series the prevalence of new diagnosis was high (over 40%).

Hemodialysis.com: Were any of the findings unexpected?

In this study, our analysis was focused on CKD stage 1 patients, both in comparison with a cohort of 267 low-risk pregnancies, and with 49 patients in later CKD stages.

At difference with our previous study, in which the results recorded in stage 1 and stage 2 CKD were almost equal, the stepwise increase along stages is more clear and statistical difference is reached between stage 1 and 2 CKD as for birth weight and gestational age.

Therefore, even minor differences in kidney function (stage 2 vs stage 1) increase the risk for adverse pregnancy related outcomes.

Hemodialysis.com: What should clinicians and patients take away from your report? 

Since our data show an increased risk for adverse pregnancy-related morbidity in all CKD stages, all patients with chronic kidney disease should be followed within dedicated tailored programs since stage 1.

A multidisciplinary team composed by obstetricians, nephrologists, internists, anesthetists and neonatologists, should be involved in the management of these patients.

In fact, an adequate monitoring during pregnancy presumably improves the maternal fetal outcomes.

Moreover, it's important to perform a careful counseling in women with CKD who want babies: the main risks must be explained in detail.

Hemodialysis.com : What recommendations do you have for future research as a result of this study?  

We hope to be able to organize a multicentre study to analyze the role of specific kidney diseases in determining materno-foetal outcomes and to test on a larger scale our policy of tailored diagnostic and management protocols.

Reference:

Pregnancy in CKD: whom should we follow and why? Barbara Giorgina Piccoli, Federica Fassio, Rossella Attini, Silvia Parisi, Marilisa Biolcati, Martina Ferraresi, Arianna Pagano, Germana Daidola, Maria Chiara Deagostini, Piero Gaglioti, and Tullia Todros
Nephrol. Dial. Transplant. first published online July 6, 2012 doi:10.1093/ndt/gfs302