Pregnancy and Kidney Disease Progression in Autosomal Dominant Polycystic Kidney Disease

BACKGROUND: Data are conflicting regarding whether pregnancy influences disease progression in women with autosomal dominant polycystic kidney disease (ADPKD). This study examined whether pregnancy or number of pregnancies were associated with kidney disease progression in women with ADPKD. METHODS: Women with early- (Study A) and late-stage (Study B) ADPKD from the Halt the Progression of Polycystic Kidney Disease (HALT-PKD) trials were included to examine the association between self-reported number of pregnancies (categorical predictor: no pregnancy vs. 1-2 pregnancies and ≥3 pregnancies), annual slope of estimated glomerular filtration rate (eGFR), annual percent change in total kidney volume (%ΔTKV) and a composite outcome (kidney failure, 50% decline in eGFR, or death) using multivariable linear regression and Cox proportional hazard models. Additionally, women who became pregnant, had full-term pregnancies, and available data during study participation (n=13) were propensity matched (1:4) to women who were not pregnant during study participation, and a mixed model was applied to determine the association of pregnancy with eGFR slope and %ΔTKV. RESULTS: Across all analyses, 455 women with a median age of 45 (IQR: 38-50) years and eGFR of 69+25 ml/min/1.73m2 at baseline were included. 199 women had 1-2 pregnancies and 165 women had ≥3 pregnancies. There was no association of 1-2 pregnancies or ≥3 pregnancies (vs. no pregnancies) with eGFR slope (Beta-estimate [95% Confidence interval]; 1-2 pregnancies: 0.22 [-0.44,0.89]; ≥3 pregnancies: -0.46 [-1.16, 0.25]), %ΔTKV (Beta-estimate [95% CI]; 1-2 pregnancies: 0.92 [-0.34, 2.17]; ≥3 pregnancies: 0.69 [-0.67, 2.04]), or time to composite outcome (Hazard ratio [95% CI]; 1-2 pregnancies: 1.04 [0.56, 1.93]; ≥3 pregnancies: 1.48 [0.78, 2.77]) in adjusted models. Moreover, there was no difference in annual eGFR slope (Beta-estimate:-0.14 [95% CI: -2.72, 2.44]) and %ΔTKV (Beta-estimate:0.04 [95% CI: -3.74, 3.82]) in women who became pregnant during HALT matched to women who did not became pregnant during HALT. CONCLUSIONS: Pregnancy was not associated with ADPKD progression among women with early and late-stage ADPKD enrolled in the HALT-PKD trials.