肾病是产妇死亡危险因素

圣迭戈——科罗拉多大学的Shailendra Sharma博士在美国肾脏病学会(ASN)主办的2012肾脏周上报告称，肾病孕妇面临更高的不良产妇结局风险，包括独立于潜在共病之外的产妇死亡率风险增加。

Sharma博士指出：“对于妊娠期任何程度的肾病，均应及时诊治，因为我们现在了解到这些疾病可导致未来不良结局，是不可低估的因素。”
 

Shailendra Sharma博士

Sharma博士及其同事回顾性研究了2000~2011年在科罗拉多州和犹他州Intermountain 医疗机构(IHC)分娩的646例肾病孕妇的病历资料，并随机选择62,757例无肾病的孕妇作为对照。研究者按照ICD-9疾病编码确认肾病孕妇，不良产妇结局定义为早产(早于37周)、剖宫产、住院时间以及产妇死亡。应用多变量逻辑回归分析考察肾病与不良产妇结局的相关性，充分校正后的模型考虑了产妇年龄、种族、糖尿病、慢性高血压、肝病及结蹄组织疾病史等协变量因素。

患者平均年龄28岁。分析结果显示，与无肾病孕妇相比，肾病孕妇更多患有糖尿病(12% vs. 1%)、慢性高血压(2% vs. 7%)、肝病(9% vs. 1%)、结蹄组织疾病(7% vs. 0.4%)等共病，发生先兆子痫/子痫(11% vs. 3%)、平均住院时间较长(3 d vs. 2 d)、婴儿平均体重较轻(3,067 g vs. 3,325 g)的比例也显著较高。

校正年龄、种族、糖尿病、高血压、肝病和结蹄组织疾病史后，肾病孕妇死亡(OR，3.38)、早产(OR，1.95)、剖宫产(OR，1.38)以及住院时间延长(OR，1.39)风险显著增加。

研究者称：“最令人震惊的的是，肾病与产妇死亡率存在关联，关联强度出乎意料。” 研究者承认该研究存在回顾性设计的局限性，并指出，如果针对上述问题进一步开展前瞻性研究，将有助于确认因果关系。

该研究由美国国立糖尿病消化病肾病研究所资助，Sharma博士声称无相关利益冲突披露。

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By: DOUG BRUNK, Internal Medicine News Digital Network

SAN DIEGO – Pregnant women with kidney disease face an increased risk of adverse maternal outcomes including maternal mortality independent of underlying comorbid conditions that can occur with kidney disease, according to Dr. Shailendra Sharma.

"Any degree of kidney disease during pregnancy should be recognized and should be treated promptly with respect because we now know that can lead to bad outcomes down the road," Dr. Sharma said in an interview during a poster session at the Kidney Week 2012. "This is not something that should be underestimated."

Dr. Sharma, a second-year renal fellow at the University of Colorado, Aurora, and his associates retrospectively studied the records of 646 women with kidney disease who gave birth in Colorado and Utah between 2000 and 2011 at facilities operated by Intermountain Health Care. For comparison, the researchers randomly selected the records of 62,757 pregnancies from women without kidney disease.

Kidney disease was defined by ICD-9 code, and adverse maternal outcomes were defined as preterm delivery (prior to 37 weeks’ gestation), delivery by cesarean section, length of hospital stay, and maternal death. The researchers used multivariate logistic regression analysis to examine the association between kidney disease and adverse maternal outcomes. Covariates included in the fully adjusted model were maternal age, race, history of diabetes, chronic hypertension, liver disease, and connective tissue disorders.

The mean age of patients was 28 years. Compared with women who did not have kidney disease, those who did were significantly more likely to have comorbid conditions including diabetes (12% vs. 1%, respectively); chronic hypertension (2% vs. 7%); liver disease (9% vs. 1%); and connective tissue disorders (7% vs. 0.4%). They also were more likely to have preeclampsia/eclampsia (11% vs. 3%), to have a longer hospital stay (a mean of 3 vs. 2 days), and to give birth to a lower-weight infant (a mean of 3,067 g vs. 3,325 g).

After the investigators adjusted for age, race, history of diabetes, hypertension, liver disease, and connective tissue disorders, Dr. Sharma and his associates found that pregnant women with kidney disease had a significantly increased risk of death (OR, 3.38); preterm delivery (OR, 1.95); delivery via C-section (OR, 1.38); and longer length of hospital stay (OR, 1.39). "The most striking finding was the association of kidney disease with maternal mortality," Dr. Sharma said at the meeting, which was sponsored by the American Society of Nephrology. "The magnitude of this association surprised us."

He said that the retrospective design of the study is a limitation. "If there’s a prospective study moving forward, specifically designed to answer these questions, then it probably would help us establish the causality."

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Sharma said he had no relevant financial conflicts to disclose.