Racial disparities and factors associated with pregnancy in kidney transplant recipients in the United States

Pregnancies in Women With Kidney Failure on Home Dialysis in the United States

Introduction

Women with kidney failure have impaired fertility and are at a higher risk of maternal and fetal morbidity and mortality. Little is known about pregnancies in women receiving maintenance home dialysis in the United States.

Methods

Using data from the United States Renal Data System (USRDS), a cohort of 26,387 women aged 15 to 49 years with kidney failure receiving maintenance home dialysis from 2005 to 2018 was examined. We calculated pregnancy rates and identified factors, including the modality associated with pregnancy receiving home dialysis.

Results

Overall, 437 pregnancies were identified in 26,837 women on home dialysis. The unadjusted pregnancy rate was 8.6 per 1000 person-years (PTPY). The unadjusted pregnancy rate was higher on home hemodialysis (16.0 vs. 7.5 PTPY) than on peritoneal dialysis. Women receiving home hemodialysis had a higher adjusted likelihood of pregnancy than women receiving peritoneal dialysis (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.79-3.05). Compared with women aged 20 to 24 years, the likelihood of pregnancy was lower in women aged 30 to 34 years (HR, 0.64; 95% CI, 0.43-0.96), 35 to 39 years (HR, 0.53; 95% CI, 0.35-0.79), 40 to 44 years (HR, 0.32; 95% CI, 0.21-0.49), and 45 to 49 years (HR, 0.21; 95% CI, 0.13-0.33). Whereas Black women had a higher likelihood of pregnancy (HR, 1.40; 95% CI, 1.07-1.83), there was no difference in likelihood of pregnancy in Asian, Hispanic, and Native Americans as compared to Whites. Body mass index, cause of kidney failure, socioeconomic status, rurality, predialysis nephrology care, or dialysis vintage were not significantly associated with pregnancy on home dialysis.

Conclusion

The pregnancy rate in women with kidney failure undergoing home dialysis is higher with home hemodialysis than with peritoneal dialysis. Younger age and Black race or ethnicity are associated with a higher likelihood of pregnancy among women receiving home dialysis. This information can guide clinicians in preconception counselling and making informed treatment decisions for pregnant women on home dialysis.

Parenthood with kidney failure: Answering questions patients ask about pregnancy

Achieving parenthood can be an important priority for women and men with kidney failure. In recent decades, the paradigm has shifted toward greater support of parenthood, with advances in our understanding of risks related to pregnancy and improvements in obstetrical and perinatal care. This review, codesigned by people with personal experience of kidney disease, provides guidance for nephrologists on how to answer the questions most asked by patients when planning for parenthood. We focus on important issues that arise in preconception counseling for women receiving dialysis and postkidney transplant. We summarize recent studies reflecting pregnancy outcomes in the modern era of nephrology, obstetrical, and perinatal care in developed countries. We present visual aids to help clinicians and women navigate pregnancy planning and risk assessment. Key principles of pregnancy management are outlined. Finally, we explore outcomes of fatherhood in males with kidney failure.

Embarazo y trasplante renal. Una revisión sistemática

Introducción: El trasplante renal es la mejor opción como tratamiento renal sustitutivo, por sus múltiples beneficios, permitiendo además a las mujeres con enfermedad renal crónica la posibilidad de embarazo y de una gestación exitosa.Objetivo: Conocer y sintetizar la producción científica más actualizada sobre el embarazo en mujeres con trasplante renal.Metodología: Se realizó una revisión sistemática siguiendo las recomendaciones de la declaración PRISMA, en las bases de datos PubMed, ProQuest, Scielo y Scopus. La estrategia de búsqueda se estableció con los siguientes descriptores: “pregnancy” y “kidney transplantation”. Se incluyeron artículos originales y revisiones sistemáticas, en español e inglés publicados entre 2015 y 2020.Resultados: Se seleccionaron 18 artículos. Se encontró una edad media de las mujeres trasplantadas en el momento del parto entre los 30 y 34 años y un tiempo medio entre el trasplante renal y el embarazo de 4,2 años. Las complicaciones más frecuentes en la madre fueron la preeclampsia, la hipertensión arterial inducida por el embarazo y la infección del tracto urinario, así como un aumento de la creatinina sérica y proteinuria. La mayoría de los embarazos terminaron en cesáreas y, entre los nacidos vivos, existió un gran número de prematuros.Conclusiones: El embarazo en mujeres con trasplante renal resulta exitoso siempre que la función renal se mantenga estable y no aparezcan complicaciones. Las complicaciones más frecuentes durante el embarazo son la hipertensión y la preeclampsia. La complicación más frecuente en el neonato es la prematuridad.

Contraceptive use among women with kidney transplants in the United States

Background

Kidney transplant improves reproductive function in women with end-stage kidney disease. Little is known about contraceptive use in women with history of kidney transplants.

Methods

Using data from the United States Renal Data System, we evaluated for each calendar year women with kidney transplantation between 1/1/2005 and 12/31/2013 who were aged 15–44 years with Medicare as the primary payer and linked data from the United Network for Organ Sharing, for up to three entire years after the date of transplantation. We determined rates of contraceptive use and used multivariable logistic regression to identify factors associated with contraceptive use.

Results

The study cohort included 13,150 women and represented 26,624 person-years. The rate of contraceptive use was 9.5%. Compared to women aged 15–24 years, contraceptive use was lower in women aged 30–34 years (OR 0.67; CI 0.58–0.78), 35–39 years (OR 0.36; CI 0.31–0.43), and 40–44 years (OR 0.23; CI 0.19–0.28). Compared to white women, contraceptive use was higher both in black women (OR 1.26; CI 1.10–1.43) and Native American women (OR 1.52; CI 1.02–2.26). Women had lower rates of contraceptive use in the second-year post-transplant (OR 0.87; CI 0.79–0.94) and the third-year post-transplant (OR0.69; CI 0.62–0.76) than in the first-year post-transplant. Women with a history of diabetes had a lower likelihood of contraceptive use (OR 0.80; CI 0.65–0.99).

Conclusion

Among women with kidney transplants, contraceptive use remains low at 9.5%. Factors associated with a higher likelihood of contraceptive use include younger age and black and Native American race/ethnicity; and second- and third-year post-transplant. The history of diabetes is associated with a lower likelihood of contraceptive use. The study highlights the need of increasing awareness for safe and effective contraceptive use in women with kidney transplants.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40620-021-01181-0.