Ali, Anam

Maynard, Sharon E, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Research Scholars Gestational Change in Estimated Glomerular Filtration Rate (eGFR) and Risk of Adverse Pregnancy Outcomes (First Place) Anam Ali Sharon E. Maynard MD Follow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars  Part of the Medicine and Health Sciences Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Lehigh Valley Health Network, Allentown, Pennsylvania• Chronic kidney disease (CKD) is estimated to affect 3% of women in their childbearing years.1 – Glomerular filtration rate (GFR) is an easily obtainable metric that provides an estimate of kidney function.• In normal pregnancy, GFR increases up to 40-50%.2 • In patients without CKD, a smaller gestational increase in eGFR is associated with adverse pregnancy outcomes.3References1. Munkhaugen J, Lydersen S, Romundstad PR, Wideroe TE, Vikse BE, Hallan S. Kidney function and future risk for adverse pregnancy outcomes: a population-based study from HUNT II, Norway. Nephrology Dialysis Transplantation. 2009;24(12):3744-3750. doi:10.1093/ndt/gfp3202. Fakhouri F, Schwotzer N, Cabiddu G, et al. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int. 2023;103(2):264-281. doi:10.1016/j.kint.2022.10.0293. Park S, Lee SM, Park JS, et al. Gestational estimated glomerular filtration rate and adverse maternofetal outcomes. Kidney Blood Press Res. 2018;43(5):1688-1698. doi:10.1159/000494746• Pending approval of the study protocol, analysis will be carried out to determine statistical significance and the degree of association between study variables.• The results of this study may help clinicians better identify a subgroup of patients that may benefit from additional prenatal care to monitor for adverse outcomes.BACKGROUNDMETHODSRESULTSCONCLUSIONFUTURE STEPSGestational Change in Estimated Glomerular Filtration Rate (eGFR) and Risk of Adverse Pregnancy OutcomesAnam Ali and Sharon E. Maynard, MDDepartment of Medicine, Division of NephrologyOBJECTIVES• Women with proteinuria and/or hypertension are at high risk for preeclampsia and other adverse pregnancy outcomes.• The finished study protocol was submitted to the Department of Medicine for the first step of the research approval process.• The objectives of this proposed study are to: – Determine whether lower baseline eGFR is associated with a smaller gestational increase in eGFR in pregnant women with CKD– Determine if a smaller gestational increase in eGFR is associated with a higher incidence of adverse pregnancy outcomes in pregnant women with CKD• Use descriptive statistics to characterize patients seen within the Pregnancy Hypertension Kidney Center (PHKC)DevelopConduct a thorough literature review and write a protocol to submit to LVHN’s 3-step research approval processCollectRetrospective chart review of 192 patients seen in PHKC from August 2011 - July 2023 and entered into REDCap databaseAnalyzeDescribe patients seen in PHKC by demographics, clinical diagnoses, and pregnancy outcomesFigure 2: Baseline estimated glomerular filtration rate (eGFR) among patients in PHKC. Mean:98 mL/min/1.73m2SD: 28 mL/min/1.73m2Diabetic Nephropathy8%Lupus Nephritis18%Polycystic Kidney Disease18%Reflux Nephropathy1%Focal Segmental Glomerulosclerosis2%IgA Nephropathy9%Other44%Figure 1: Chronic kidney disease etiologies Patient DemographicsAge (mean, SD) 31.5 (5.7)EthnicityHispanic or Latino 42 (21.9%)Not Hispanic or Latino 141 (73.4%)Unknown 9 (4.7%)RaceWhite 117 (60.9%)Asian 9 (4.7%)Black/African American 21 (10.9%)Multiracial 10 (5.2%)Other/Unknown 35 (18.2%)Tobacco Use 16 (8.3%)Alcohol Use 3 (1.6%)Clinical CharacteristicsComorbiditiesChronic Hypertension 81 (42.2%)History of Preeclampsia 44 (22.9%)Rheumatological Disease 32 (16.7%)Thyroid Disease 24 (12.5%)Diabetes Mellitus 18 (9.4%)Pulmonary Disease 18 (9.4%)Nephrology DiagnosesProteinuria 117 (60.9%)Chronic Kidney Disease 95 (49.5%)Stage 1 55 (59.7%)Stage 2 13 (13.7%)Stage 3 18 (18.9%)Stage 4 2 (2.1%)Stage 5 1 (1.1%)Hematuria 50 (26.0%)Electrolyte Disorder 26 (13.5%)Gestational Diabetes 22 (11.5%)Gestational Hypertension 21 (10.5%)History of Kidney Transplant 7 (3.6%)Pregnancy OutcomesGestational age at delivery, in weeks (mean, SD)36 weeks (4.3 weeks)Birthweight, in grams (mean, SD) 2752 gAdverse Maternal OutcomesPreeclampsia 53 (36.3%)Preeclampsia Severe FeaturesSevere hypertension 29 (54.7%)New/persistent headache 22 (41.5%)Visual disturbances 5 (9.4%)Persistent epigastric pain 2 (3.8%)Placental abruption 5 (3.4%)Seizure 1 (0.7%)Adverse Neonatal OutcomesPreterm birth (<37 weeks) 66 (43.4%)Very preterm birth (<32 weeks) 20 (13.2%)IUGR* less than 10th percentile 27 (18.5%)Prenatal/neonatal death 9 (6.2%)02468101214160-15 16-30 31-45 46-60 61-75 76-90 91-105 106-120 121-135 136-150 151-165 166-180FrequencyeGFR (in mL/min/1.73m2)Please use the QR code to access the submitted draft of the study protocolTable 1: Comorbidities and nephrology diagnoses for patients seen in PHKCTable 2: Pregnancy outcomes for patients seen in PHKCTable 3: Demographics for patients seen in PHKC*IUGR = Intrauterine growth restriction

Gestational Change in Estimated Glomerular Filtration Rate (eGFR) and Risk of Adverse Pregnancy Outcomes (First Place)

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Gestational Change in Estimated Glomerular Filtration Rate (eGFR) and Risk of Adverse Pregnancy Outcomes (First Place)

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