Andrea G. Kattah

Key Points: Compared with kidney donors with uncomplicated pregnancies, donors with prior adverse pregnancy events did not have altered kidney structure at donation. Kidney function 10 years after donation was comparable between donors with and without prior adverse pregnancy outcomes. Prior adverse pregnancy outcomes do not translate into subclinical kidney injury in otherwise healthy donor candidates. Background: Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm delivery are associated with higher long-term cardiovascular, metabolic, and kidney disease risk. Their implications for living kidney donation remain uncertain. Methods: We conducted a retrospective cohort study of 498 female living kidney donors (2000–2017) from the Mayo Clinic Living Donor Program with documented pregnancy histories, predonation computed tomography angiography, implantation kidney biopsy, and measured GFR. Donors with prior HDP ( n =45), GDM ( n =18), or preterm delivery ( n =65) were compared with donors without adverse pregnancy outcomes (APOs; n =385). Kidney morphometry, histology, and function were analyzed with adjustment for age at donation and first pregnancy, parity, and hypertension. Postdonation kidney outcomes were assessed using surveys and medical record review. Results: Donors with prior HDP and GDM had higher body mass index at donation (+7.9% and +8.9%; P = 0.006 and 0.04), whereas donors with preterm delivery had lower body mass index (−4.8%; P = 0.03) compared with donors with no APO. After adjustment, donors with HDP showed no differences in kidney volumes, biopsy features, or kidney function at donation or during follow-up. Donors with GDM had larger total and cortical kidney volumes (9.5%–10%), less arterial luminal stenosis, and higher 5-year postdonation eGFR (+15%; P = 0.03). Donors with preterm delivery had a lower risk of eGFR 2 (hazard ratio, 0.28; P = 0.03). Conclusions: Prior APOs were not associated with adverse kidney structure at donation or accelerated kidney function decline postdonation. These findings support that APO history alone should not preclude living kidney donation when other eligibility criteria are met.

Background: Women with advanced chronic kidney disease (CKD) encounter reproductive health challenges, including reduced fertility, menstrual irregularity, and sexual dysfunction. This study examined changes in sex hormones in patients with CKD, their correlation with sexual function, and changes after transplant. Methods: This study recruited women aged 18–51 years with CKD stages 3b-5 from outpatient clinics and dialysis units. Exclusion criteria included active pregnancy, menopause, prior hysterectomy/bilateral oophorectomy, or use of hormonal contraceptives/therapy. Data were collected at enrollment and at 6 months post-transplant. Results: Thirty-eight subjects met eligibility criteria and enrolled in the trial (8 in CKD stage 3b, 10 in CKD stage 4, and 20 in CKD stage 5/5D). Sexual dysfunction (25/38, 65.8%), defined as total female sexual function index score < 26.55, and menstrual irregularities (17/38, 44.7%) were common, with abnormal elevation of luteinizing hormone present in the follicular phase in the majority of patients. There was a significant negative association between total female sexual function index score and prolactin (β = -0.26, P = 0.03) and dehydroepiandrosterone sulfate (β = -0.07, P = 0.01) after adjusting for age. After transplant, there was also a significant improvement in both prolactin and dehydroepiandrosterone sulfate levels, although sexual dysfunction persisted. Conclusions: This study highlights the complex interplay between advanced CKD, reproductive endocrinology, and sexual health. Significant hormonal dysregulation and associated reproductive challenges were observed. The prominent role of dehydroepiandrosterone sulfate in sexual dysfunction among women with CKD requires further study.

Purpose of review Hypertensive disorders of pregnancy are associated with maternal morbidity, mortality, hospital readmissions, and significant costs to healthcare systems. Recent findings The incidence of hypertensive disorders of pregnancy (HDP) and maternal morbidity is higher in rural areas than in urban areas. The interaction of rural residence, race, and non-medical drivers of health can create significant barriers to post-partum care in rural communities. Novel models of care, including remote blood pressure monitoring, telehealth, and application-based approaches, may offer ways to reach rural patients after hypertensive pregnancy. Summary There are significant opportunities to create novel multi-modal and multi-disciplinary approaches to post-partum care of HDP. Tailoring and evaluating the approach in rural communities is an important next step to improve care.

Key Points: This study demonstrates that peritoneal dialysis is a safe and feasible option for patients with autosomal dominant polycystic kidney disease, even with high cystic organ volumes. Larger organ volumes, including height-adjusted cumulative kidney and liver volume, were not associated with increased peritoneal dialysis–related complications. Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic kidney disorder and the fourth leading cause of kidney failure. Peritoneal dialysis (PD), preferred for its home-based convenience and cost-effectiveness, is often underutilized in ADPKD because of concerns over enlarged kidneys and heightened risk of complications. Methods: This retrospective cohort study used data from the Mayo Clinic Polycystic Kidney Disease Database to evaluate individuals with ADPKD undergoing PD. We analyzed demographics, clinical parameters, and PD-related parameters. Complications were correlated with kidney and liver volumes derived from pre-kidney failure imaging. Results: A total of 155 individuals with ADPKD on PD were included, of whom 45.1% were male. The mean age at PD initiation was 54.3±12.8 years, and the mean body mass index was 28.0±7.0 kg/m ² . The median duration of PD was 24.3 months (interquartile range [IQR], 10.7–43.1), with 21.9% transitioning to hemodialysis. The most common complications were abdominal hernias (30.3%) and peritonitis (23.9%), with a peritonitis rate of 0.11 episodes per patient-year. Imaging analyses performed on a subset of 50 patients showed a median height-adjusted total kidney liver volume of 2731.9 ml/m (IQR, 2102.5–3131.1) and a median height-adjusted total kidney volume of 1303.5 ml/m (IQR, 733.1–1829.4). Kaplan–Meier analysis demonstrated no differences in complications rates on the basis of height-adjusted total kidney liver volume or height-adjusted total kidney volume (above versus below median values) or body mass index categories. Multivariate Cox regression analysis revealed that higher height-adjusted cumulative organ volume was associated with a lower risk of PD-related complications (hazard ratio=0.56, P = 0.026). Conclusions: PD is a safe and feasible treatment option for patients with ADPKD, with no increased risk of PD-related complications associated with larger height-adjusted cumulative organ volumes. Infectious complication rates in this cohort were within International Society of Peritoneal Dialysis guideline thresholds, further supporting the safety of PD in this population.