Experience in managing pregnant women with chronic kidney disease of different stages

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OBJECTIVE

Formation of an algorithm for the management of pregnant women with CKD to improve obstetric, perinatal and nephrological outcomes.

MATERIAL AND METHODS

The proposed algorithm for the management of pregnant women with chronic kidney disease is based on an analysis of the management and outcomes of pregnancy in 311 patients with CRF of different stages: 197 with stage I (CKD I), 46 with stage II (CKD II), 55 pregnant women with stage III (CKD III), 7 pregnant women with stage IV CKD (CKD IV), 6 pregnant women with end-stage CKD (CKD V) undergoing renal replacement therapy with hemodialysis. The key indicators of homeostasis have been identified on the basis of which dynamic monitoring should be carried out in this cohort of patients, and the effectiveness of the proposed management tactics has been proven.

RESULTS

The article substantiates the need for pregnancy planning in this group of women, presents the frequency of possible gestational complications, their prevention and treatment based on indicators of dynamic control of the main parameters of homeostasis developed for this contingent of patients. The criteria for predicting the outcome of pregnancy, conditions for prolongation of pregnancy in kidney diseases and medical indications for its artificial termination are presented, as well as methods of delivery are discussed. When using the proposed algorithm in patients with stages I and II of CKD, adverse pregnancy outcomes were absent, with stage III CKD, a 5-fold decrease in the total proportion of losses of desired pregnancies in all three trimesters was achieved (from 56.0 to 10.5%). In the group without this algorithm, the total proportion of losses in all trimesters of pregnancy corresponded to 49.4% in CKD I and 46.2% in CKD II.

CONCLUSION

The presented algorithm for the management of pregnant women with CKD can significantly improve pregnancy outcomes in women with chronic kidney disease, even in the presence of chronic renal failure.

Keywords:

pregnancy

stages of chronic kidney disease

main indicators of homeostasis for dynamic control of kidney function and fetal condition

algorithm for the management of pregnant women with chronic kidney disease

Authors:

Nikol’skaya I.G.

Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

ORCID: 0000-0002-5579-0084

Novikova S.V.

Moscow Regional Research Institute of Obstetrics and Gynecology

ORCID: 0000-0001-7303-0268

Prokopenko E.I.

M.F. Vladimirskii Moscow Regional Clinical Research Institute

ORCID: 0000-0002-7686-9816

Bychkova N.V.

M.F. Vladimirskiy Moscow Regional Research Clinical Institute

ORCID: 0000-0001-9082-5978

Nefedov P.P.

Moscow Regional Research Institute of Obstetrics and Gynecology

ORCID: 0009-0001-3141-3954

Mar’yanova T.A.

Moscow Regional Clinical Research Institute of Obstetrics and Gynecology

ORCID: 0000-0002-2440-0178

Received:

23.11.2023

Accepted:

02.12.2023

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