Abstract: SA-OR32
Mortality and Transplant After Delivering on Hemodialysis: A Matched Cohort Study
Session Information
- Epidemiology of CKD Progression: Who, Why, and When?
November 04, 2023 | Location: Room 119, Pennsylvania Convention Center
Abstract Time: 05:06 PM - 05:15 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Oliverio, Andrea L., University of Michigan Medical School, Ann Arbor, Michigan, United States
- Wang, Mia, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States
- Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Heung, Michael, University of Michigan Medical School, Ann Arbor, Michigan, United States
Background
Rates of successful pregnancies among women with ESKD on hemodialysis (HD) are increasing, however risk of preeclampsia and cesarean delivery remain high. Subsequent mortality and transplantation after delivery on HD are unknown.
Methods
Using USRDS data, women treated with HD who delivered an infant between 2002 and 2019 were identified from ICD-9/10-CM codes and matched up to 1:4 by age, vintage, race and ethnicity, and diabetes as primary cause of ESKD to contemporary women on HD who did not deliver. We assessed mortality and transplantation rates over time. A Cox proportional hazards model was fit to compare mortality and transplantation rates between delivering and non-delivering women. Logistic regression was used to evaluate 1 and 5 year transplant rates for delivering vs. non-delivering female patients. All models were adjusted for age, vintage, BMI, race, Hispanic ethnicity, incident comorbidities, area deprivation index, rural-urbanicity, nephrology care pre-ESKD, Medicare insurance, and prior transplant history; patient waitlist status and PRA values were also adjusted in the transplant models.
Results
1,109 delivering women were matched to 4,404 non-delivering women. Unadjusted mortality and transplantation rates for delivering vs non-delivering women were 4.5 vs 7.2 and 6.0 vs. 8.6 per 100 patient-years, respectively (Figure). In adjusted models, the HR (95% CI) for mortality and transplant are 0.69 (0.64, 0.74; p<.0001) and 0.76 (0.71, 0.81; p<0.0001), respectively, in delivering compared to non-delivering women. 1 and 5 year transplantation rates were lower in delivering women compared to non-delivering women.
Conclusion
While pregnancy on hemodialysis is associated with significant risk of preeclampsia and preterm delivery, delivery on hemodialysis was associated with a lower risk of subsequent mortality. Residual confounding may explain superior survival of delivering women vs. non-delivering women, however persistently lower transplant rates in delivering women warrant further research.
Funding
- NIDDK Support