Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2016

Short and mid term renal function in patients with Type 1 and Type 2 Diabetes during and post Pregnancy (#28)

Jas-mine Seah 1 2 3 , Cara Tanner 2 , Ning Mao Kam 2 , Lydia Wong 2 , Leonid Churilov 3 4 , Alexis Shub 1 , Christine Houlihan* 1 2 5 , Elif I. Ekinci* 2 3 5
  1. Mercy Hospital For Women, Melbourne, VIC
  2. Endocrinology, Austin Health, Heidelberg, VIC
  3. Medicine Austin Health, University of Melbourne, Melbourne
  4. Florey Department of Neuroscience and Mental Health, Heidelberg, VIC
  5. *, Equal Contribution

Background:

We conducted an exploratory retrospective study at a single tertiary obstetric hospital with an aim to investigate the short and mid term progression of renal function in pregnancies affected by T1DM and T2DM compared to healthy controls. We hypothesized that renal function returns to pre-pregnancy levels slower in women with T1DM and T2DM compared to controls.

Methods:

Biochemical and clinical characteristics of women with T1DM (n=91), T2DM (n=106) and healthy controls (n=119) were recorded 2 years-pre, at time of, and 2 years-post pregnancy from state-wide pathology services. We examined the relationship between time, diabetes status and the rate of decline in renal function as determined by estimated Glomerular Filtration Rate (eGFR) using the Chronic Kidney Disease Epidemiology Cohort formula utilizing a median regression model. eGFR at 0-6 months pre-pregnancy was considered baseline renal function, with age and duration of diabetes as independent variables.

Results:

Women from all three groups developed a rise in renal function during pregnancy, peaking in the second trimester, in keeping with hyperfiltration (graph1). The greatest rise was observed in healthy controls with a median of 25ml/min/1.73m2 (95%CI18.2, 30.2;p<0.001), which was 16.7ml/min/1.73m2 (95%CI -24.1,-9.4;p< 0.001) greater than in T1DM and 14.6ml/min/1.73m2 (95%CI -21.8,-7.4; p<0.001) in T2DM.

Renal function returned to baseline quickest in healthy controls at a median rate of 0.07ml/min/1.73m2/day (95%CI -0.09,-0.06;p<0.001)) followed by T1DM 0.05ml/min/1.73m2/day (95%CI -0.07,-0.03;p<0.001)) and T2DM 0.01ml/min/1.73m2/day (95%CI -0.02,-0.00;p<0.01). Overall, renal function returned to baseline by 2 years in all three groups.

Conclusions:

Acknowledging the limitation of eGFR as a measure of renal function in pregnancy,the degree of hyperfiltration appears to be less in women with pre-existing diabetes. Furthermore, despite a slower recovery in renal function,pregnancy does not appear to be associated with worsening renal function in this cohort of T1DM and T2DM women with relatively preserved renal function.

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