Year: 2023
Type: article
Abstract: There is a clarion call to disrupt the ongoing maternal morbidity and mortality health equity crisis in the US.This crisis has worsened across the overall US population over the past 2 decades, and it has disproportionately burdened Alaska Native, American Indian, and Black 1 individuals, heightening the need for our collective attention.Studies designed to better understand the causes for this crisis and its associated social inequities are emerging, and the rising prevalence of chronic conditions such as hypertension and diabetes among pregnant women has drawn scrutiny as these are important potential contributing factors for poor pregnancy outcomes and racial and ethnic disparities.2 Chronic kidney disease has been implicated as an additionally important potential risk factor for poor pregnancy outcomes.3 Pregnancy-related acute kidney injury is associated with adverse maternal outcomes.4 However, little has been known regarding the characteristics of pregnant individuals who develop pregnancy-related end-stage kidney disease (PRESKD) or factors that may contribute to their poor health outcomes.Kucirka et al 5 conducted a national retrospective observational cohort study to characterize individuals at risk for PRESKD and to elucidate potential associations with their health outcomes.Using data obtained from 183 649 reproductive-aged women with incident ESKD between 2000 and 2020, they described the prevalence and characteristics of individuals with PRESKD, and they studied these individuals' time to mortality, access to kidney transplant (joining a waiting list or receiving a living donor kidney), and time to transplant after waitlisting when compared with individuals with non-PRESKD.Although the prevalence of PRESKD was relatively low (341 total individuals identified), Black individuals had disproportionately greater (nearly double) representation among the population of individuals with incident PRESKD when compared with the proportion of Black individuals in the 2020 general birthing population (31.9% vs 16.2%).Individuals with PRESKD also had a nearly 5-fold greater prevalence of diabetes and 27-fold greater prevalence of hypertension when compared with the general birthing population.Compared with women with other causes of ESKD, those with PRESKD were more likely to have a reported Hispanic ethnicity and Medicaid as a primary insurer.After adjustment for race, ethnicity, insurance type, employment, and comorbidities, individuals with PRESKD had similar mortality risk as individuals with ESKD due to glomerulonephritis and cystic kidney disease (adjusted inverse hazard ratio [aHR], 0.96; 95% CI, 0.76-1.19),and lower mortality risk than individuals with diabetes and hypertension (aHR, 0.49; 95% CI, 0.39-0.61;P < .001) or other causes of ESKD (aHR, 0.60; 95% CI, 0.48-0.75)respectively.However, individuals with PRESKD had less access to kidney transplant when compared with individuals with all other causes of ESKD including glomerulonephritis or cystic kidney disease (adjusted subhazard [aSHR], ratio 0.51; 95% CI, 0.43-0.66)diabetes and hypertension (aSHR, 081; 95% CI, 0.67-0.98),or other or unknown causes (aSHR, 0.82; 95% CI, 0.67-0.99).Furthermore, individuals with PRESKD were less likely than those with glomerulonephritis or cystic disease, diabetes and hypertension, or other causes to have comprehensive kidney care (33.6% vs 58.1%-77.6%),or graft or arteriovenous fistula dialysis access placement before incident ESKD.This study is one of the first in the US to describe the prevalence and characteristics of individuals with PRESKD and to characterize factors potentially associated with their inequitably poor health outcomes.Kucirka et al 5 did not perform analyses formally evaluating racial or ethnic differences in outcomes among individuals with PRESKD.However, minoritized individuals were +
Source: JAMA Network Open
Authors: Dinushika Mohottige, L. Ebony Boulware
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W4389490122