Placenta-associated complications in women with chronic kidney disease: prevalence and status of the maternal hemostasis system

Introduction. Women with chronic kidney disease (CKD) are at high risk of developing placenta-associated complications.

Aim. To investigate the prevalence of placenta-associated complications and characterize maternal hemostasis in pregnant women with CKD.

Patients and methods. This prospective observational study included 150 women with CKD stages G1-G3 in the second trimester of pregnancy: CKD G1 – 58, CKD G2 – 45, CKD G3 – 47 patients. The CKD stage was determined according to KDIGO criteria for estimated glomerular filtration rate (eGFR) in women with known before pregnancy serum creatinine and endogenous creatinine clearance at study entry. Between 28 and 39.5 weeks of gestation, 55 patients developed preeclampsia combined with fetoplacental insufficiency, and 19 had preeclampsia with fetoplacental insufficiency and acute kidney injury (AKI). A comparison group included 20 healthy women with uncomplicated pregnancies. Observation lasted 13-27 weeks before delivery, and maternal. The study and analysis of the maternal hemostasis parameters were analyzed in the third trimester.

Results. The overall frequency of placenta-associated complications in pregnant women with CKD G1-G3 was 50.7%, compared to 0% in women without CKD (HR 10.1 95% CI 1.5; 68.9). Among CKD stages, the complication rates were 34,9% in G1-G2, and 80,9 % in G3 (HR 2.3, 95% CI 1.7; 3,1), similar across glomerular and non-glomerular pathologies. Women with placenta-associated complications showed increased in platelet counts with thrombocrit, elevated homocysteine, fibrinogen, and D-dimer levels, and decreased activated partial thromboplastin time compared with healthy women with uncomplicated pregnancies. The addition of AKI was associated with a trend toward lower platelet counts and serum homocysteine and D-dimer levels. Serum creatinine negatively correlated with platelet count (p=0.046), thrombocyte (p=0.007), and mean platelet volume (p=0.001), and positively correlated with fibrin level (p=0.048). Daily proteinuria correlated directly with fibrinogen (p=0.005) and D-dimer (p=0.007) the levels.

Conclusion. Pregnant women with CKD are at high risk for developing placenta-associated complications and exhibit complex maternal hemostasis disturbances, leading of a hypercoagulable state.

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