PREGNANCY-ASSOCIATED PROGRESSION OF CHRONIC KIDNEY DISEASE: DEVELOPMENT OF A CLINICAL PREDICTIVE TOOL

TY - JOUR

T1 - PREGNANCY-ASSOCIATED PROGRESSION OF CHRONIC KIDNEY DISEASE: DEVELOPMENT OF A CLINICAL PREDICTIVE TOOL

AU - Ralston, Elizabeth

AU - Clery, Amanda

AU - Wang, Yanzhong

AU - Wiles, Kate

AU - Blakey, Hannah

AU - Lipkin, Graham

AU - Hall, Matt

AU - Lightstone, Liz

AU - Chappell, Lucy

AU - Webster, Philip

AU - Carr, Sue

AU - Bramham, Kate

PY - 2021

Y1 - 2021

N2 - Introduction: Pregnancy in women with chronic kidney disease (CKD) is associated with high rates of adverse pregnancy outcomes including renal dysfunction. Current risk estimates for pregnancy associated progression of renal disease are based on outdated studies and do not enable individual risk prediction. Our aim is to develop a prediction tool that estimates the magnitude of pregnancy associated progression of renal disease in women with CKD. Methods: Data from four UK cohort studies were combined to create a development dataset. Women with an estimated glomerular filtration rate (eGFR CKD-EPI) between 30-90 mls/min/1.73m2within 12 months preconception were included. The primary outcome chosen by women and healthcare professionals was eGFR <30 mls/min/1.73m2 between 6 weeks and 12 months postpartum. Each predictor was tested in a univariable logistic regression model to estimate crude associations. Significant and clinically relevant predictors were included in a multivariable model using backwards elimination. Area under the curve values (AUROC) were calculated with 95% confidence intervals (CI). Results: The cohort included 200 women with 220 pregnancies (mean age at conception 31.8 years, mean eGFR 54.93 mls/min/1.73m2). Pre pregnancy eGFR (Odds Ratio [OR] 0.9, 95% CI 0.8 - 0.9), proteinuria (OR for mild and moderate 1.5, 95% CI 0.5 - 4.3) and chronic hypertension (OR 3.4, 95% CI 1.3 - 10.5) were independently associated with postpartum eGFR <30 mls/min/1.73m2 and in combination produced a strong model with an AUROC of 0.90 (CI 0.84 - 0.95) with sensitivity and specificity at 94% and 75% respectively. Conclusions: We have developed a prediction tool with high performance for estimation of a postpartum eGFR <30 mls/min/1.73m2 which could have important clinical value. Further external validation is needed prior to introduction into routine care.

AB - Introduction: Pregnancy in women with chronic kidney disease (CKD) is associated with high rates of adverse pregnancy outcomes including renal dysfunction. Current risk estimates for pregnancy associated progression of renal disease are based on outdated studies and do not enable individual risk prediction. Our aim is to develop a prediction tool that estimates the magnitude of pregnancy associated progression of renal disease in women with CKD. Methods: Data from four UK cohort studies were combined to create a development dataset. Women with an estimated glomerular filtration rate (eGFR CKD-EPI) between 30-90 mls/min/1.73m2within 12 months preconception were included. The primary outcome chosen by women and healthcare professionals was eGFR <30 mls/min/1.73m2 between 6 weeks and 12 months postpartum. Each predictor was tested in a univariable logistic regression model to estimate crude associations. Significant and clinically relevant predictors were included in a multivariable model using backwards elimination. Area under the curve values (AUROC) were calculated with 95% confidence intervals (CI). Results: The cohort included 200 women with 220 pregnancies (mean age at conception 31.8 years, mean eGFR 54.93 mls/min/1.73m2). Pre pregnancy eGFR (Odds Ratio [OR] 0.9, 95% CI 0.8 - 0.9), proteinuria (OR for mild and moderate 1.5, 95% CI 0.5 - 4.3) and chronic hypertension (OR 3.4, 95% CI 1.3 - 10.5) were independently associated with postpartum eGFR <30 mls/min/1.73m2 and in combination produced a strong model with an AUROC of 0.90 (CI 0.84 - 0.95) with sensitivity and specificity at 94% and 75% respectively. Conclusions: We have developed a prediction tool with high performance for estimation of a postpartum eGFR <30 mls/min/1.73m2 which could have important clinical value. Further external validation is needed prior to introduction into routine care.

U2 - https://doi.org/10.1016/j.ekir.2021.03.248

DO - https://doi.org/10.1016/j.ekir.2021.03.248

M3 - Meeting abstract

SN - 2468-0249

VL - 6

JO - Kidney International Reports

JF - Kidney International Reports

IS - 4

ER -