Dr Alice Wookey1,2, A/Prof Paul Champion de Crespigny2,3, Prof Shaun Brennecke1,4
1Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Australia, 2Department of General & Obstetric Medicine, The Royal Women’s Hospital, Parkville, Australia, 3Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia, 4University of Melbourne Department of Obstetrics, Gynaecology and Newborn Health, Parkville, Australia
Biography:
Alice Wookey is an Advanced Physician Trainee in General and Obstetric Medicine, based at the Royal Melbourne Hospital. Her main research interests centre on disorders of placental development and function (including pre-eclampsia), and she is a current research affiliate of the Pregnancy Research Centre at the Royal Women’s Hospital.
Abstract:
Background: The soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio blood test is being increasingly incorporated into the routine screening and assessment of pregnant women at high risk for developing pre-eclampsia (PE), including those with pre-existing chronic kidney disease (CKD). The current study builds on previously published data from our centre regarding the clinical utility of this PE predictive biomarker test in renal transplant patients, instead focusing more broadly on non-renal transplant CKD subtypes.
Aim: To investigate the predictive value of the sFlt-1/PlGF ratio blood test in non-renal transplanted pregnant women with CKD and suspected superimposed PE.
Methods: Retrospective analysis from a single tertiary centre of pregnant women who birthed between January 2018 and December 2023. PE status was confirmed according to predefined international clinical criteria. CKD cases were defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines based on the first pregnancy visit and/or preconception data. Predictive accuracy of the sFlt-1/PlGF ratio for ruling in/out a diagnosis of PE within 4 weeks was assessed using a sFlt-1/PlGF ratio cut-off of 38.
Results: A total of 37 non-transplant CKD pregnancies were identified, including 10 cases with superimposed PE. The positive predictive value of the sFlt-1/PlGF ratio for ruling in PE within 4 weeks was 83.3%. Conversely, the negative predictive value of sFlt-1/PlGF ratio for ruling out the development of PE within 4 weeks was 92.6%.
Conclusion: This work highlights the potential for the sFlt-1/PlGF ratio to be incorporated into routine clinical practice in non-renal transplanted pregnant women with pre-existing CKD. This is particularly important given the clinical diagnosis of PE may prove challenging in this cohort, due to overlapping clinical features such as escalating hypertension and proteinuria.