Preeclampsia during pregnancy can accelerate CKD
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Key takeaways:
- Overall, 44 patients with chronic kidney disease and preeclampsia had a decrease in eGFR of more than 30%.
- Researchers evaluated 103 patients with CKD and preeclampsia vs. 103 matched controls with CKD.
Patients with chronic kidney disease who have preeclampsia during pregnancy may face higher risk for long-term kidney function decline or end-stage kidney disease, data show.
“In addition to pregnancy itself accelerating renal function decline in CKD patients, complications during pregnancy, such as preeclampsia, can further accelerate kidney function decline in CKD patients,” Zheng Li, of the department of obstetrics and gynecology at Peking University, First Hospital in Beijing, wrote with colleagues. “CKD patients with early onset preeclampsia during pregnancy have a faster renal function decline than patients with late-onset preeclampsia and without preeclampsia.”
In a retrospective cohort study, researchers evaluated 103 patients with CKD and preeclampsia during pregnancy and 103 matched controls with CKD but not preeclampsia. The aim was to analyze the link between preeclampsia and kidney function deterioration.
Investigators followed patients for at least 1 year after first pregnancy, from 2009 to 2022.
According to the findings, 44 patients with CKD and preeclampsia had a decrease in eGFR of more than 30% or developed ESKD, compared to 20 patients without preeclampsia.
In addition, eGFR decline was more significant in patients with preeclampsia, with a rate of decrease of 17.38% vs. 10.05% in patients without preeclampsia, the research showed.
Further, multivariate analysis showed early onset preeclampsia of before 34 weeks of gestation and late-onset preeclampsia were risk factors for an eGFR decrease of more than 30% or ESKD, according to Li and collogues. Compared to patients with CKD and no preeclampsia, patients with early onset preeclampsia and CKD had a HR of 2.61 and those with late-onset preeclampsia and CKD had a HR of 2.54.
“Preeclampsia was associated with a greater risk of long-term kidney function decline or ESKD among CKD patients, especially in patients with early onset preeclampsia,” they wrote.
Perspective
Back to TopAnna Burgner, MD, MEHP, and Alissa A. Ice, MD
Preeclampsia is the most common glomerular disease in the world, yet there remains a paucity of data regarding the long-term sequelae, particularly amongst patients with chronic kidney disease.
Generally, patients with preeclampsia, which is characterized by endothelial dysfunction, are at increased risk for cardiovascular complications, diabetes and CKD, but the implications to CKD progression have been poorly defined.
In this retrospective cohort study, Li and colleagues showed an increased risk of kidney outcomes, including the percentage change in the eGFR and end stage kidney disease, at a median postpartum follow up of five years in patients with CKD and preeclampsia compared to those who had not developed preeclampsia. This risk was seen even amongst those with early stages of CKD and was particularly evident for those with early-onset preeclampsia, defined as preeclampsia before 34 weeks of gestation.
Though preeclampsia can be challenging to recognize in patients with CKD, hypertension and/or proteinuria, these findings emphasize the importance of remaining cognizant of the disease and its associated risk factors, including CKD, given both the short- and long-term health effects, such as kidney disease. With the increasing incidence of preeclampsia, modifying risk factors, monitoring, educating patients and employing preventative strategies are essential in mitigating these risks. Additional studies are imperative to further elucidate the long-term effects of preeclampsia among patients with CKD. In addition, this study should be a further call to arms to increase interest in this area to determine novel preventative strategies and treatments. Research has been lacking for far too long.
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