ABSTRACT
Background
Preeclampsia occurs in 3-5% of pregnancies and can lead to potentially fatal outcomes
for parent and child. Disparities in socio-economic status, medical access, racial/ethnical
and regional background within the United States result in a very heterogenic population.
Objective
We aimed to assess the regional differences in severity of chronic kidney disease
in pregnant patients and risk of preeclampsia in a contemporary cohort within the
United States.
Design
Pregnant patients were identified within the National Inpatient Sample database between
2015 and 2019. Patients were stratified by diagnosis of end stage kidney disease or
chronic kidney disease. The primary endpoint of this study was to determine the incidence
of mild preeclampsia, severe preeclampsia and eclampsia in hospitalized pregnant patients
with kidney dysfunction compared to controls. Secondary endpoints were to determine
regional, racial/ethnical and socio-economic differences within the United States.
Results
A total of 16,343,563 pregnant patients were identified within 2015-2019. Presence
of chronic kidney disease increased risk of mild and severe preeclampsia independent
of the stage of chronic kidney disease (Odds ratio >2 each). There was a significant
difference in prevalence of chronic kidney disease in regard to geographic location
within the United States, with patients in the Northeast having predominantly milder
stages of chronic kidney disease and patients in the South and West having more progressive
kidney disease. There was a significant difference in chronic kidney disease distribution
in relation to racial/ethnical background within the United States. Black and Latinx
patients were at increased risk of eclampsia and death. There was no significant difference
regarding chronic kidney disease and socio-economic background. However, a larger
proportion of patients with very low income had advanced stages of chronic kidney
disease.
Conclusions
Our data adds to the prior findings that patients with chronic kidney disease are
at increased risk of developing preeclampsia even in the modern era of medical management,
independent of the cause of chronic kidney disease. Racial/ethnical and geographical
differences in chronic kidney disease prevalence exist. A multi-disciplinary team
approach to follow pregnant patients with chronic kidney disease could decrease the
maternal and neonatal mortality.
Keywords
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Article info
Publication history
Accepted:
March 8,
2023
Received in revised form:
March 6,
2023
Received:
October 24,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
