MO080: Pre-Eclampsia in Patients With Chronic Kidney Disease (CKD)
Authors: Kozlovskaya Natalia , Alekseeva Mariya , Demyanova Kseniya , Korotchaeva Yulia , Chegodaeva Ayana , Apresyan Sergey 
Published: May 2022

Abstract

BACKGROUND AND AIMS
CKD is a significant risk factor for preeclampsia (PE). However, the features of PE in this cohort of patients (pts) have not been previously studied in detail. In this regard, the analysis of PE in pts with CKD is of great clinical and social importance. The aim of the study is to analyze the incidence and characteristics of PE in pts with CKD

METHOD
A retrospective analysis of 60 case histories of pregnant women with CKD (1–4 stages) was carried out, 27 of which had CKD st. 3a-4, followed in the dedicated center from 2018 to 2021. About 10 (37%) women with CKD 3a-4 developed PE, then the course of their pregnancy was analyzed. Indicators of creatinine, proteinuria and blood pressure were assessed at the time of the first visit to the center and further at the time of PE. The physiological response of the kidneys to pregnancy was assessed in six women in whom the value of creatinine before pregnancy was known as a decrease in creatinine concentration by 10% from the initial (before pregnancy). In 6 out of 10 women, the baseline pre-gestational SCr was available, and the physiological kidney response to pregnancy, which was considered as a persistent decrease in SCr by at least 10% from the baseline level, was assessed. In four pts, there was no information about blood creatinine before pregnancy.

RESULTS
In the group of pts with PE and advanced CKD, the mean age was 32.3 (±4.8) years (from 28 to 42 years). The most common cause of CKD was GN—6 (60%) and one each—tubulointerstitial nephritis, diabetic nephropathy, aHUS, APS-associated nephropathy. CKD C3a: 4 (40%) pts, C3b: 3 (30%) and C4: 3 (30%) pts. Complicated obstetric history (PE, antenatal fetal death) had 3 (30%) of 10 pts. The mean term of gestation at the time of first visit to nephrologist was 15.6 weeks. At the first measurement during pregnancy, the mean Scr was 157 (±69) μmol/L; the physiological response of the kidneys to pregnancy was noted only in 1 out of 6 pts. The mean proteinuria was 1.2 (±0.8) g/L. Arterial hypertension had 3 (30%) pts and only 1 woman received antihypertensive therapy before pregnancy with the achievement of target BP values. The mean blood pressure at the first visit was: SBP 131 (±11.5)/DBP 84 (±7.3) mm. Hg. Aspirin for the prevention of PE was prescribed in a timely manner in six cases (60%); in 4 pts (40%) aspirin was either not prescribed or was added to therapy after 12 weeks of pregnancy. Anticoagulant therapy with LMWH was prescribed before 28 weeks of gestation for patients with PU &gt;1 g/day (seven cases). Combined antiplatelet and anticoagulant therapy was performed in 4 (40%) cases.
PE before 34 weeks of gestation (early PE), developed in 7 (70%) pts, and the mean term for the development of PE was 31.3 weeks [27; 36.5]. The mean blood pressure at the moment of PE was 142 (±17)/90 (±10.6) mm Hg. The majority of women showed an increase in proteinuria (Table 1). The development of AKI was noted in six cases (Table 1). Another sign of a severe course of PE was thrombocytopenia in two cases (less than 100 thousand in 1 μL), in one of them as the part of HELLP syndrome. The markers of PE (sFLT1, PLGF, sFLT1/PLGF) were analyzed in five (50%) cases. The mean value of the ratio at the moment of PE was: sFLT1/PLGF: 157.6 that for a given gestational term (31.3 weeks) corresponds to severe ischemic damage to the placenta.
The mean delivery term was 32.4 weeks of gestation; all newborns were alive and viable with the mean weight 1514 g (978–2250 g).

CONCLUSION
According to our data, the main features of PE in pts with advanced CKD are its early onset (up to 34 weeks), severe course with AKI in 60% of cases, with relatively low BP values.