Study Finds Insufficient Care for Women with Pregnancy-Related Kidney Disease

Pregnant Black women had double the rate of end-stage kidney disease than their peers, highlighting disparities in treatment, the researchers found.

Expectant mothers with pregnancy-related kidney problems often have lower access to necessary medical care and kidney transplants than other patients with end-stage kidney disease, according the findings of a new study.

Researchers warn that among all women, Black women were more likely to suffer from pregnancy-related end-stage kidney disease than patients of other races and ethnicities, which appears to be the result of disparities in treatment options available for many minorities and low-income communities.

In findings published this month in the medical journal JAMA Network Open, researchers from the University of North Carolina at Chapel Hill examined data on 183,000 women with end-stage kidney disease between 2000 and 2020. They used data from the U.S. Renal Data System and maternal data from births captured by the U.S. Centers for Disease Control and Prevention, finding 341 patients with pregnancy as the primary cause of end-stage kidney disease.

According to the study, patients with pregnancy-related end-stage kidney disease (ESKD) were 53% less likely to receive nephrology care before they were diagnosed with end-stage kidney disease compared to other kidney disease patients.

Expectant mothers with pregnancy-related ESKD were 69% less likely to receive a graft or arteriovenous fistula placed before end-stage onset. They were also less likely to receive a kidney transplant, researchers concluded.

The disparity came despite data indicating that women with pregnancy kidney disease have similar or better survival rates than patients with other types of kidney problems. However, the researchers determined that they are less likely to be referred to specialized doctors or have access to medical care.

The largest disparities in the quality of care were seen among Black women, the researchers noted. Pregnancy-related end-stage kidney disease was more common among Black patients, who may be twice as likely to develop the condition, according to the data.

Pregnancy-Related Kidney Disease Risks

Pregnancy puts a lot of stress on the human body and can be a cause of kidney injury or renal disease. Women who suffer from pregnancy-related ESKD face other pregnancy complications like high blood pressure, preeclampsia, or worsened kidney function, leading to end-stage kidney disease where the patient requires dialysis or a kidney transplant.

End-stage kidney disease can cause serious side effects to both the mother and child, including restricting fetal growth, likelihood of preeclampsia, preterm birth, hypertension, seizures, and can increase the risk of death to both the mother and child.

Patients with pregnancy-related kidney disease face a lower risk of death compared to other conditions, including cystic kidney disease, diabetes, and hypertension. However, the incidence of pregnancy-related kidney disease is increasing. Roughly 3% of pregnant women, or about 100,00 women, suffer from pregnancy-related kidney injury in the U.S. every year, the researchers warn.

“In this study, those with pregnancy-related ESKD had reduced access to transplant and nephrology care, which could exacerbate existing disparities in a disproportionately Black population,” the researchers concluded. “Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival.”