SP373ESTABLISHING A JOINT MATERNAL MEDICINE AND NEPHROLOGY CLINIC FOR PATIENTS WITH PREGNANCY IN CKD

Abstract

Introduction and Aims: Background Pregnant women with chronic kidney disease(CKD) have higher than average rates of maternal and neonatal complications. They benefit from both pre-pregnancy counselling and multidisciplinary antenatal care which includes input from maternal medicine and nephrology. Data on pregnancy in kidney disease are soon to be recorded in the Renal Association 'National Registry of Rare Kidney Diseases' (RaDaR). Clinic Structure We established a maternal medicine and nephrology clinic in October 2012. The clinic is run once per month. Patients are seen jointly by one of two maternal medicine specialists and a consultant nephrologist, as well as having any necessary investigations including foetal imaging. The clinic offers pre-pregnancy counselling, antenatal and post-natal care. Patients already known to our nephrology service are seen exclusively at our clinic during their pregnancy and need not attend general nephrology or transplant clinic appointments. The aim was to provide a necessary service and obviate the need for these patients to attend multiple centralised specialist clinic appointments, reducing inconvenience and offering consultant-led continuity of care. The service will allow more comprehensive data-capture for our contribution to RaDaR. The local structure of the service means that the majority of patients under the care of the Bristol renal unit with pregnancy in CKD are seen at our clinic. Methods: Data were collected from October 2012 to December 2014 (26 months). A retrospective review of electronic and physical notes was performed. Results: 47 patients were seen over 95 clinic appointments. 38 had CKD, 9 has kidney transplants. None were receiving dialysis. Of those with kidney transplants, 6 became pregnant; 4 have delivered to date, 2 by caesarean section and 2 by normal vaginal delivery. Two deliveries were between 32 and 37 weeks gestation, and 2 were at term. Birth weights were all above 2.5kg. Of those with CKD, 17 became pregnant and there were 16 live births and one early miscarriage. In total, 20 patients were seen for pre-pregnancy counselling. There has been an increase in the number of referrals for pre-pregnancy counselling as the service has become established. Conclusions:We have been successful in establishing a valuable service for patients with pregnancy in CKD, which has been well-received. Our service delivers coordinated multidisciplinary care for patients and we look forward to reporting our outcomes when more data are available. This type of clinic would be transferrable to other centres with large renal and maternal medicine departments.