Clinical practice guideline on pregnancy and renal disease

Background Chronic kidney disease (CKD) is estimated to affect 3% of pregnant women in high-income countries, (Piccoli et al., 2018, #13860) which equates to between 15,000–20,000 pregnancies per year in England. The prevalence of CKD in pregnancy is predicted to rise in the future due to increasing maternal age and obesity. Although CKD is not a barrier to reproduction in most women, the risk of adverse pregnancy outcomes is increased in women with CKD including pre-eclampsia, fetal growth restriction, preterm delivery and accelerated loss of maternal renal function. CKD impacts on communication, decision-making, and the surveillance and management of women before, during, and after pregnancy. Existing guidance on the management of CKD in pregnancy includes the UK Consensus Group on Pregnancy in Renal Disease (ISBN 978–1,107,124,073) and expert review. Neither Kidney Disease Outcomes Quality Initiative (KDOQI) or National Institute of Health and Care Excellence (NICE) have produced specific guidance on the management of renal disease in pregnancy. Published guidance containing information relevant to the care of women with CKD in pregnancy includes: KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). UK Renal Association Commentary available at: BMC Nephrology 2018; 19: 240. KDOQI Clinical Practice Guideline for Haemodialysis, 2015. KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD, 2012 KDIGO Clinical Practice Guideline for Glomerulonephritis, 2012 KDIGO Guideline for the Care of Kidney Transplant Recipients, 2009. KDIGO Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, 2008. NICE: Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and their Babies NG121, 2019. NICE: Urinary Tract Infection (Lower) Antimicrobial Prescribing NG109, 2018 NICE: Urinary Tract Infection (Recurrent) Antimicrobial Prescribing NG112, 2018. NICE: Antenatal Care for Uncomplicated Pregnancies CG62, 2008, updated 2017. NICE: Vitamin D supplement use in specific population groups PH56, 2017 NICE: Diabetes in Pregnancy: Management from Pre-conception to the Post-partum Period NG3, 2015. NICE: Antenatal and postnatal mental health: clinical management and service guidance CG192, 2014, updated 2018. NICE: Fertility: Assessment and Treatment for People with Fertility Problems, 2013. NICE: Weight management before, during and after pregnancy PH27, 2010 additional data from 2017 surveillance available at: https://www.nice.org.uk/guidance/ph11/evidence/appendix-a-summary-of-evidence-from-surveillance-pdf-4671107966 NICE: Hypertension in Pregnancy: Diagnosis and Management CG107, 2011 (update awaited 2019). UK Renal Association Clinical Practice Guidelines: Undernutrition in Chronic Kidney Disease, June 2019 RCOG: Thrombosis and Embolism During Pregnancy and the Puerperium, Reducing the Risk Green-Top Guideline 37a, 2015. MBBRACE Confidential Enquiry into Maternal Deaths and Morbidity: lessons learned to inform maternity care (triennial reports) www.european-renal-best-practice.org/content/erbp-documents