This article is more than 5 years old. Information may no longer be current.
Women who develop preeclampsia are at five-times greater risk for ESKD
Click Here to Manage Email Alerts
Women who had no major comorbidities before their first pregnancy but who developed preeclampsia had a five-fold increased risk for end-stage kidney disease, according to a recently published study.
“The scientific community has become increasingly aware of sex-specific influences on the incidence and progression of renal disorders,” Ali S. Khashan, PhD, of University College Cork in Ireland, and colleagues wrote. “Moreover, women’s reproductive history seems to play an important role in the subsequent risk of developing chronic kidney disease, [but] national guidelines are still lacking the support to address the link between pregnancy history and later renal dysfunction. Preeclampsia has been suggested to increase the risk of end-stage kidney disease; however, most studies were unable to adjust for potential confounders including preexisting comorbidities such as renal disease, [diabetes] and cardiovascular disease.”
To examine the association between preeclampsia and ESKD risk, researchers used data from the Swedish Medical Birth Register and identified 1,366,441 women who had live births between 1982 and 2012 and who did not have a diagnosis of CKD, CVD, hypertension or diabetes prior to their first pregnancy. Women were categorized as having no preeclampsia, preeclampsia in first pregnancy or no preeclampsia in first pregnancy but in later pregnancies. Using information from ICD codes, preeclampsia was defined as a diastolic blood pressure of greater than 90 mmHg accompanied by proteinuria. Maternal age, BMI, education, native country and smoking were adjusted for as potential confounders.
Researchers noted that women were more likely to develop an ESKD with longer follow-up, with the median interquartile range follow-up being 7.4 years and 16.4 years among women with an ESKD diagnosis.
During the study period, 4.9% of women had at least one preeclampsia diagnosis and 410 were diagnosed with ESKD. Researchers observed that the incidence rate of ESKD per 100,000 person-years was 1.85 among women with no preeclampsia vs. 12.35 among women who had preeclampsia.
An association was also found between preeclampsia and ESKD in both the unadjusted analysis (HR = 4.99) and the adjusted models (HR = 4.96). In addition, compared with those with no preeclampsia, women who had preterm preeclampsia or preeclampsia in two pregnancies had about a nine-fold (HR = 8.76) and seven-fold (HR = 7.13) increased risk for ESKD, respectively.
“Previous studies have shown that women with a history of preeclampsia have an increased incidence of microalbuminuria, a marker for renal disease and predictor of adverse renal outcomes,” the researchers wrote. “This suggests either that these women might have underlying previously unrecognized renal disease, which is unmasked by preeclampsia, or that preeclampsia adversely affects long-term renal function resulting in increased risk of developing CKD. We report that healthy women with preeclampsia are at a five-fold increased risk of ESKD compared with parous women with no preeclampsia. This shows that preeclampsia is a sex-specific, independent risk factor for the subsequent development of ESKD. However, it should be noted that the overall ESKD risk remains small. Whether screening and/or preventative strategies will reduce the risk of ESKD in women with adverse pregnancy outcomes is worthy of further investigation.” – by Melissa J. Webb
Disclosures: Khashan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts