Daily Dose: Pregnancy-related ESKD Influences Access to Nephrology Care

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in JAMA Network Open on the long-term outcomes of patients with pregnancy-related end-stage kidney disease (ESKD).

The study

Researchers conducted the study to examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes. They used data from the US Renal Data System, which records all patients with ESKD in the US.

The study population included 183 640 women aged 14 to 50 years with dialysis or preemptive kidney transplant from January 1, 2000, to November 20, 2020, with a primary cause of kidney failure reported.

Investigators followed participants until death or November 20, 2020 (end of study), with death confirmed using linkage to the Social Security Master Death File. They defined access to kidney transplant as, “joining the deceased donor waiting list or receiving a kidney transplant from a living donor.”

Differences in access to kidney transplant and time to transplant after joining the waitlist were evaluated to compare the hazard of death between cohorts. Differences in pre-ESKD care were evaluated by examining whether participants had access to nephrology care, arteriovenous graft or fistula, or had been informed about kidney transplant before ESKD onset.

Findings

A total of 341 patients with a pregnancy-related primary cause of ESKD were identified.

A pregnancy-related primary cause of ESKD was reported in 0.19% of patients with ESKD. Nonpregnancy causes of ESKD included diabetes in 38.1%, hypertension in 19.8%, glomerulonephritis in 21.9%, cystic kidney disease in 4.6%, and other or unknown cause in 15.3%.

Investigators found survival rates lowest in individuals with diabetes or hypertension as the primary cause of ESKD vs pregnancy-related causes and glomerulonephritis or cystic kidney disease.

Access to kidney transplant was less likely for participants with pregnancy-related ESKD compared to patients with glomerulonephritis or cystic kidney disease (adjusted inverse subhazard ratio (aSHR) 0.51, diabetes or hypertension (aSHR 0.81) or other unknown causes (aSHR 0.82).

Results also showed that patients with pregnancy-related ESKD had reduced rates of access to nephrology care before ESKD onset compared to patients with other causes of ESKD, at 33.6% vs 58.1 - 77.6%.

Authors' comment

"Though our study only included those with a pregnancy-related primary cause of ESKD, our findings may serve as a foundation to guide clinical care and future research within the much larger population of patients with pregnancy-related AKI who are at significant risk for mortality and severe morbidity."

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