Pre-eclampsia, Risk of Chronic Hypertension and KD - EMJ

Pre-eclampsia and Risk of Chronic Hypertension and Kidney Disease

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PRE-ECLAMPSIA is a pregnancy-related complication associated with acute hypertension and end-organ dysfunction. A recent study suggests that females who are pregnant with pre-eclampsia are at an increased risk of chronic hypertension, reduced kidney function, and albuminuria. The research team, led by Nityasree Srialluri, Johns Hopkins University, Baltimore, Maryland, USA, conducted an observational cohort study to evaluate the long-term association between preeclampsia and the risk of developing chronic hypertension and kidney disease.

The study included 27,800 females who were pregnant, of which 10.7% had at least one pregnancy complicated by pre-eclampsia (n=2,977). The research team used propensity score matching to generate a matched control group, resulting in the inclusion of 4,552 females in total.

Results suggested females who had experienced pre-eclampsia had higher rates of later developing chronic hypertension (hazard ratio [HR]: 1.77; 95% confidence interval [CI]: 1.45–2.16), an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 (HR: 3.23; 95% CI: 1.64–6.36), and albuminuria of at least 300 mg/g (HR: 3.60; 95% CI: 2.38–5.44). Pre-eclampsia was significantly associated with a 1.8-fold increase in the risk of developing chronic hypertension; a 3.2-fold risk of an estimated glomerular filtration rate less than 60 mL/min/1.73 m2; and a 3.6-fold risk of albuminuria. Subsequently, the risk of further incidence of pre-eclampsia was 24.8-fold higher for females with a first episode, compared with those without.

Overall, the research team concluded that individuals with a pregnancy complicated by pre-eclampsia have a higher risk of hypertension, reduced estimated glomerular filtration rate, and albuminuria compared with individuals without. They acknowledge that the scope of the study is limited due to its observational nature, its reliance on International Classification of Diseases (ICD) codes for medical diagnosis, and in that the population was primarily white. Furthermore, post-partum follow-up testing rates were low. For example, only 31% and 14% of females with and without pre-eclampsia had serum creatinine tests, respectively, and 26% completed albuminuria testing in each group. Srialluri concluded: “Taken together, our findings suggest that individuals who develop pre-eclampsia during pregnancy constitute a high-risk population for kidney disease and merit closer monitoring for early prevention of long-term consequences.”

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