Pregnancy-Related ESKD Linked to Disparities in Care

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Black women have disproportionately high rates of pregnancy-related end stage kidney disease (ESKD), associated with disparities in access to nephrology care and kidney transplantation, reports a study in JAMA Network Open.

The researchers analyzed data from 183,640 women of reproductive age with incident ESKD between 2000 and 2020, drawn the from the US Renal Data System and the US Centers for Disease Control and Prevention. From this cohort, 341 patients with pregnancy-related ESKD were identified. Patient characteristics and outcomes were analyzed, including the impact of pre-ESKD nephrology care.

A pregnancy-related primary cause of ESKD was identified in 0.19% of patients. Black women accounted for 31.9% of women with pregnancy-related ESKD compared with 16.2% of the general birthing population.

On multivariable analysis, patients with pregnancy-related ESKD had mortality similar to that of patients with glomerulonephritis or cystic kidney disease and lower than those with diabetes or hypertension (hazard ratio [HR], 0.49) or other/unknown primary causes of ESKD (HR, 0.60).

Despite its high mortality risks, patients with pregnancy-related ESKD had lower access to kidney transplantation compared with those with glomerulonephritis or cystic kidney disease (HR, 0.51), diabetes or hypertension (HR, 0.81), and unknown/other causes (HR, 0.82). Pregnancy-related ESKD was also associated with a lower likelihood of nephrology care (adjusted relative risk [RR], 0.47) or placement of a graft or arteriovenous fistula before ESKD onset (RR, 0.31).

Pregnancy-related acute kidney injury (AKI) is rising in incidence, with a substantial risk of maternal morbidity including ESKD. The study provides new evidence on the characteristics and outcomes of pregnancy-related ESKD, including racial disparities, in the incidence and care for this condition.

“Despite having equivalent or better survival with ESKD, access to transplant among those with pregnancy-related ESKD was surprisingly low, and appeared to be at least partly related to a lack of pre-ESKD nephrology care,” the researchers conclude. They add, “[O]ur 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” [Kucirka LM, et al. Characteristics and outcomes of patients with pregnancy-related end-stage kidney disease. JAMA Netw Open 2023; 6:e2346314. doi: 10.1001/jamanetworkopen.2023.46314].