Pregnancy and Long-Term Kidney Function in CKD: A Systematic Review and Meta-Analysis.
A systematic review and meta-analysis found that pregnancy does not measurably worsen long-term kidney function in women with mild CKD, but is associated with a significant decline in advanced CKD — providing reassurance for early-stage disease and a basis for individualized counseling.
Background
Pregnancy may accelerate kidney-function decline in women with CKD, leading some clinicians to advise against it, but the true impact and which subgroups (e.g., proteinuria, hypertension) are most at risk had remained uncertain. This review synthesized the available evidence to inform counseling of CKD patients who wish to conceive.
Study design
Systematic review and meta-analysis of 36 human studies (2945 patients, 4623 pregnancies) plus 12 animal studies. The primary outcome was the standardized mean difference (SMD) in kidney function before versus after pregnancy; studies were stratified into mild versus advanced CKD (≤25% vs >25% of participants at CKD stage 3–5) and by chronic hypertension prevalence.
Key findings
In mild CKD cohorts, pregnancy had no effect on long-term kidney function (SMD −0.22, 95% CI −0.56 to 0.13) over a mean 4.4 years. In advanced CKD cohorts, kidney function was significantly lower after pregnancy (SMD −0.55, 95% CI −0.80 to −0.30; pooled eGFR decline −8.96 ml/min). Chronic hypertension significantly worsened the overall effect. Pooled incidence of kidney failure/replacement therapy was 9% over a mean 6.5 years. Animal models showed no pregnancy effect in mild nephropathy.
Clinical implications
Women with mild CKD can be reassured that pregnancy is unlikely to harm long-term kidney function, whereas those with advanced CKD should be counseled about the real risk of decline. The scarcity of studies with paired pre- and post-pregnancy eGFR slopes limits separating pregnancy's effect from natural disease progression in advanced CKD.
Category
Research
Source
Clinical Journal of the American Society of Nephrology (CJASN)
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