WCN25-4616 MATERNAL-FETAL OUTCOMES IN PREGNANT WOMEN WITH CHRONIC KIDNEY DISEASE: A RETROSPECTIVE MEXICAN COHORT STUDY

fetal/neonatal survival, kidney function and hypertension at discharge, at 3 months and 6 months post-partum.Results: The study enrolled 231 patients with PRAKI, of which 52 (22.5%) had expired.The mean age was 27.4 AE 3.8 years.96% had institutional delivery.The most common cause of maternal mortality was puerperal sepsis (48.5%), followed by obstetric hemorrhage (44.5%) and preeclampsia (39%).Primary outcome Patient level factors-Patients who died were more likely to have underlying comorbidities (p 0.002), have unplanned pregnancies (p 0.00), have higher Sequential Organ Failure Assessment (SOFA) Score at day 0 and day 3 of admission (p 0.028), require blood transfusion (p 0.04) andinotropes (p 0.012).Provider and Policymaker level factors -Social determinants of maternal mortality were delayed presentation after symptom onset (p 0.00), referral from more than one medical facility (p 0.01), and patient residence outside Mumbai (p 0.02).100% of patients had out-of-pocket expenses during admission despite being covered under the Janani Suraksha Yojana (government scheme for perinatal coverage).Two women succumbed due to lack of access to a dialysis facility post-discharge.After multivariate adjustments, higher SOFA scores on day 3, delayed presentation after symptom onset, and referral from more than one medical facility independently predicted maternal mortality.Secondary Outcomes Preterm delivery was seen in 64% of pregnancies.Birth weight was < 2.5 kgs in the majority of neonates.Only 52.1% of pregnancies lead to a living child one month post-partum.Complete renal recovery at discharge was seen in 42.5%.At the last follow-up available, 8.1% of individuals developed chronic kidney disease.Conclusions: PRAKI continues to have high rates of maternal and fetal mortality.Higher SOFA scores, delayed presentation, and lack of access to optimum care at primary and secondary levels (leading to multiple referrals) independently predicted maternal deaths.Based on the results of this study, reforms are suggested at patient, provider, and policymaker levels to eliminate this preventable cause of mortality (Figure 1).I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.