Hypertensive disorders of pregnancy and the risk of chronic kidney disease: A Swedish registry-based cohort study
Peter M. Barrett aff001; Fergus P. McCarthy aff002; Marie Evans aff004; Marius Kublickas aff005; Ivan J. Perry aff001; Peter Stenvinkel aff004; Ali S. Khashan aff001; Karolina Kublickiene aff004
Působiště autorů: School of Public Health, University College Cork, Cork, Ireland aff001; Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland aff002; Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland aff003; Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden aff004; Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden aff005
Vyšlo v časopise: Hypertensive disorders of pregnancy and the risk of chronic kidney disease: A Swedish registry-based cohort study. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003255
Kategorie: Research Article
Hypertensive disorders of pregnancy (HDP) (preeclampsia, gestational hypertension) are associated with an increased risk of end-stage kidney disease (ESKD). Evidence for associations between HDP and chronic kidney disease (CKD) is more limited and inconsistent. The underlying causes of CKD are wide-ranging, and HDP may have differential associations with various aetiologies of CKD. We aimed to measure associations between HDP and maternal CKD in women who have had at least one live birth and to identify whether the risk differs by CKD aetiology.
Methods and findings
Using data from the Swedish Medical Birth Register (MBR), singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register (SRR) and National Patient Register (NPR; up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. Gestational hypertension was also investigated as a secondary exposure. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulointerstitial, and other/nonspecific CKD. Cox proportional hazard regression models were used, adjusting for maternal age, country of origin, education level, antenatal BMI, smoking during pregnancy, gestational diabetes, and parity. Women with pre-pregnancy comorbidities were excluded.
The final sample consisted of 1,924,409 women who had 3,726,554 singleton live births. The mean (±SD) age of women at first delivery was 27.0 (±5.1) years. Median follow-up was 20.7 (interquartile range [IQR] 9.9–30.0) years. A total of 90,917 women (4.7%) were diagnosed with preeclampsia, 43,964 (2.3%) had gestational hypertension, and 18,477 (0.9%) developed CKD. Preeclampsia was associated with a higher risk of developing CKD during follow-up (adjusted hazard ratio [aHR] 1.92, 95% CI 1.83–2.03, p < 0.001). This risk differed by CKD subtype and was higher for hypertensive CKD (aHR 3.72, 95% CI 3.05–4.53, p < 0.001), diabetic CKD (aHR 3.94, 95% CI 3.38–4.60, p < 0.001), and glomerular/proteinuric CKD (aHR 2.06, 95% CI 1.88–2.26, p < 0.001). More modest associations were observed between preeclampsia and tubulointerstitial CKD (aHR 1.44, 95% CI 1.24–1.68, p < 0.001) or other/nonspecific CKD (aHR 1.51, 95% CI 1.38–1.65, p < 0.001). The risk of CKD was increased after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who had gestational hypertension also had increased risk of developing CKD (aHR 1.49, 95% CI 1.38–1.61, p < 0.001). This association was strongest for hypertensive CKD (aHR 3.13, 95% CI 2.47–3.97, p < 0.001). Limitations of the study are the possibility that cases of CKD were underdiagnosed in the national registers, and some women may have been too young to have developed symptomatic CKD despite the long follow-up time. Underreporting of postpartum hypertension is also possible.
In this study, we found that HDP are associated with increased risk of maternal CKD, particularly hypertensive or diabetic forms of CKD. The risk is higher after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who experience HDP may benefit from future systematic renal monitoring.
Cardiovascular disease risk – Gestational diabetes – Hypertensive disorders in pregnancy – Chronic kidney disease – Labor and delivery – Preeclampsia – Pregnancy – Preterm birth
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