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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 4

(1063) Risk Of Severe Maternal Morbidity and Mortality Among Pregnant Patients with Chronic Kidney Disease

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective: Chronic kidney disease (CKD) is a significant cause of adverse obstetric outcomes, yet few studies assess the risk of severe maternal morbidity (SMM) among those with CKD. We evaluated the prevalence and association of CKD with SMM.

Study Design: This was a population-based, retrospective cohort study of U.S. delivery hospitalizations from 2010-2020 utilizing the National Inpatient Sample database. Patients were identified as having a delivery hospitalization, CKD, and SMM using International Classification Diagnoses codes (9th and 10th edition). The primary outcome of SMM was defined by the Centers for Disease Control and Prevention criteria. Multivariate logistic regression analyses were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Subgroup analyses were performed by CKD subtype, stage, race and ethnicity, and individual SMM indicators.

Results: Among 38,374,326 parturients, 77,210 (0.2%) had CKD. CKD was associated with an increased risk of SMM (aRR 7.2, 95% CI 6.7-7.6) and maternal death (aRR 4.6, 95% CI 3.2-6.4). Increased risk of SMM was associated with all CKD subtypes, stages, and a history of renal transplant. Those with CKD were at the highest risk for acute renal failure (aRR 24.4, 95% CI 22.2-26.8) and sepsis (aRR 9.3, 95% CI 7.9-11.0) (Table 1). Black individuals had a higher adjusted population attributable fraction between SMM and CKD (3.8%, 95% CI 3.5-4.1). Maternal death was significantly associated with diabetic nephropathy, renovascular, and obstructive or unspecified CKD (aRR 7.3-14.1), as well as CKD stages 3-5 (aRR 15.5-32.6). The risk of SMM and maternal death was similar in those with a history of renal transplant and those with stage 1 CKD (Figure 1). The number needed to treat with renal transplant to prevent one SMM event or maternal death in those with stages 3-5 CKD was 2.6 (95% CI 2.4-2.9) and 45.0 (95% CI 31.0-82.0), respectively. 

Conclusion: CKD in pregnancy was significantly associated with SMM, mortality, and other adverse perinatal outcomes, warranting close surveillance and multidisciplinary management throughout pregnancy.