*Article* **Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease**

**Bogdan Marian Sorohan 1,2, Andreea Andronesi 1,2, Gener Ismail 1,2,\*, Roxana Jurubita 1,2, Bogdan Obrisca 1,2, Cătălin Baston 1,3 and Mihai Harza 1,3**


Received: 11 March 2020; Accepted: 24 April 2020; Published: 27 April 2020

**Abstract:** *Background and Objectives*: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, making differential diagnosis difficult. Objective: The aim of this study was to evaluate the incidence and the clinical-biological predictors of preeclampsia in pregnant women with CKD. *Material and Methods*: We retrospectively analyzed 34 pregnant women with pre-existing CKD admitted to our department between 2008 and 2017. *Results*: Among the 34 patients, 19 (55.8%) developed PE and the mean time of occurrence was 31.26 ± 2.68 weeks of gestation. The median value of 24-h proteinuria at referral was 0.87 g/day (interquartile range 0.42–1.50) and 47.1% of patients had proteinuria of ≥1 g/day. Patients with PE tended to be more hypertensive, with a more decreased renal function at referral and had significantly higher proteinuria (1.30 vs. 0.63 g/day, *p* = 0.02). Cox multivariate analysis revealed that proteinuria ≥1 g/day at referral and pre-existing hypertension were independently associated with PE (adjusted hazard ratio = 4.10, 95% confidence interval: 1.52–11.02, *p* = 0.005, adjusted hazard ratio = 2.62, 95% confidence interval: 1.01–6.77, *p* = 0.04, respectively). The cumulative risk of PE was significantly higher in pregnant women with proteinuria ≥1 g/day at referral (log-rank, *p* = 0.003). Proteinuria ≥ 1 g/day at referral and pre-exiting hypertension predicted PE development with accuracies of 73.5% and 64.7%, respectively. *Conclusions*: Pregnant patients with pre-existing CKD are at high risk of developing preeclampsia, while proteinuria ≥ 1 g/day at referral and pre-existing hypertension were independent predictors of superimposed preeclampsia.

**Keywords:** chronic kidney disease; preeclampsia; hypertension; proteinuria
