Patients with pregnancy-related ESKD may have reduced transplant access, face racial gaps
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Key takeaways:
- Patients with pregnancy-related end-stage kidney disease were less likely to have nephrology care.
- Patients that were Black and pregnant were overrepresented among those with ESKD.
Adults with pregnancy-related end-stage kidney disease have reduced access to transplant and nephrology care, which may worsen racial gaps for Black patients with this condition, according to a study.
“Compared with other developed nations, U.S. rates of maternal mortality and severe maternal morbidity are significantly higher,” Lauren M. Kucirka, MD, PhD, of the department of obstetrics and gynecology at the University of North Carolina at Chapel Hill, wrote with colleagues.
Kucirka and colleagues wrote that the goal of the study was to “examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes.”
Investigators conducted a cohort trial of 183,640 women, at reproductive age, who had incident ESKD between 2000 and 2020. Using information from the U.S. Renal Data System and CDC, researchers studied characteristics and associations between pre-ESKD nephrology care and outcomes. Data were analyzed from December 2022 to June 2023.
Overall, 341 patients with a pregnancy-related primary cause of ESKD were identified.
Main outcomes included time to mortality, access to kidney transplant (ie, joining the wait list or receiving a live donor transplant) and transplantation after joining the wait list.
According to the findings, Black patients were overrepresented among those with pregnancy-related ESKD vs. the general birthing population at a rate of 31.9% vs. 16.2%, respectively.
Compared to patients with other causes of ESKD — researchers cited glomerulonephritis or cystic kidney disease, diabetes and hypertension — patients with pregnancy-related ESKD had similar or lower hazards of mortality, the researchers noted. Investigators emphasized, however, that despite having similar or lower hazards of mortality vs. other primary causes of ESKD, patients with pregnancy-related ESKD faced significant transplant barriers and were less likely to have nephrology care or receive a graft or arteriovenous fistula before the onset of ESKD.
“Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival,” Kucirka and colleagues wrote. “Our 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.”
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