Key result
The PREDICT tool accurately estimates postpartum eGFR decline risk in CKD with ~90% sensitivity.
Cohort (n=8,100)
Yes
The PREDICT tool provides a validated, individualized risk assessment for adverse kidney and neonatal outcomes in pregnant women with CKD.
Introduction Pre-pregnancy counselling is recommended for women with chronic kidney disease (CKD) to discuss potential adverse outcomes, yet no tools exist to estimate individual risk. We aimed to develop and externally validate two prediction models for outcomes prioritised by people with CKD and healthcare professionals: Primary outcome: probability of ≥25% reduction in estimated glomerular filtration rate (eGFR) or kidney replacement therapy (KRT) within 12-months postpartum; Secondary outcome: probability of small-for-gestational-age (<3rd percentile) infant and/or preterm delivery (<34 weeks). Methods The development cohort used linked data from the National Registry of Rare Kidney Disease, UK Renal Registry and NHS Hospital Episode Statistics. Individuals with eGFR <90 ml/min/1.73m 2 within 24-months pre-conception and deliveries between 1997–2021 were included. Validation cohorts were:(i) Ontario Pregnancy Cohort (2007–2022);(ii) three UK pregnancy-CKD studies (2010–2018). Candidate predictors were selected from known risk factors. Clinically relevant cut-points were determined with people with CKD. Results The development cohort included 746 women (median pre-pregnancy eGFR 58mL/min/1.73m 2 ); validation cohorts included 6,974 and 380 women. Optimal cut-points of 0.15 (sensitivity-90%, negative predictive value (NPV)-85%) and 0.10 (sensitivity-90%, NPV-80%) were selected for primary and secondary outcomes. External validations demonstrated high sensitivity and NPV for the primary outcome. Although comparability is limited by differing endpoints, Kidney Failure Risk Equation (KFRE) predictions (2-year) were lower than our PREDICT model (1-year) (median risk 1.4% v 48%). Conclusion We developed high performing models for individuals with CKD to predict co-selected adverse kidney and neonatal outcomes from contemporaneous cohorts. Individualised pregnancy risk assessment tools could support future parents and healthcare professionals to make informed choices.
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Ralston et al. (2026) conducted a cohort in Pregnancy-associated chronic kidney disease (CKD) (n=8,100). PREDICT Tool was evaluated on ≥ 25% reduction in estimated glomerular filtration rate (eGFR) or kidney replacement therapy (KRT) within 12 months postpartum. The PREDICT tool accurately estimated the risk of ≥25% reduction in eGFR or kidney replacement therapy within 12 months postpartum in women with CKD, achieving 90% sensitivity and 85% negative predictive value.
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