End-stage Renal Disease After Hypertensive Disorders in Pregnancy

Wu, Chia-Chun; Chen, S.H.; Ho, Chung‐Han; Liang, Fu-Wen; Chu, Chin-Chen; Wang, H.Y.; Lu, Yi-Hua

doi:10.1097/01.aoa.0000463818.02019.99

Cited by 16 publications

(22 citation statements)

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“…Most preterm deliveries occur spontaneously, but about 30% are iatrogenic and performed for obstetric reasons, typically maternal preeclampsia or intrauterine growth restriction (IUGR) [14]. Preeclampsia has been identified as a strong risk factor for ESKD [11,13,15], and women who experience IUGR or a small for gestational age (SGA) delivery may also be at increased risk of CKD [11,16]. Thus, the risk of maternal CKD/ESKD may differ depending on whether women experience spontaneous or iatrogenic preterm deliveries.…”

Section: Introductionmentioning

confidence: 99%

Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study

Barrett

McCarthy

Evans

et al. 2020

BMC Med

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Background: Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function. This study aimed to examine whether women who experience preterm delivery are at increased risk of subsequent chronic kidney disease (CKD) and endstage kidney disease (ESKD). Methods: Using data from the Swedish Medical Birth Register, singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Gestational age at delivery was the main exposure and treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox proportional hazard regression models were used for analysis. Results: The dataset included 1,943,716 women who had 3,760,429 singleton live births. The median follow-up was 20.6 (interquartile range 9.9-30.0) years. Overall, 162,918 women (8.4%) delivered at least 1 preterm infant (< 37 weeks). Women who had any preterm delivery (< 37 weeks) were at increased risk of CKD (adjusted hazard ratio (aHR) 1.39, 95% CI 1.32-1.45) and ESKD (aHR 2.22, 95% CI 1.90-2.58) compared with women who only delivered at term (≥ 37 weeks). Women who delivered an extremely preterm infant (< 28 weeks) were at increased risk of CKD (aHR 1.84, 95% CI 1.52-2.22) and ESKD (aHR 3.61, 95% CI 2.03-6.39). The highest risk of CKD and ESKD was in women who experienced preterm delivery + preeclampsia (vs. non-preeclamptic term deliveries, for CKD, aHR 2.81, 95% CI 2.46-3.20; for ESKD, aHR 6.70, 95% CI 4.70-9.56). However, spontaneous preterm delivery was also associated with increased risk of CKD (aHR 1.32, 95% CI 1.25-1.39) and ESKD (aHR 1.99, 95% CI 1.67-2.38) independent of preeclampsia or small for gestational age (SGA).

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Section: Introductionmentioning

confidence: 99%

Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study

Barrett

McCarthy

Evans

et al. 2020

BMC Med

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“…1,2 In addition, they are reported to have a 5-to 12-fold increased risk to develop end-stage kidney disease (ESKD) in studies with follow-up times ranging from 6 to 17 years postpartum. [3][4][5] The risk of chronic kidney disease (CKD) is estimated to be increased 4 to 10 times. 4 The exact course of renal function after preeclampsia that precedes the development of CKD and ESKD remains unclear and hinders the development of strategies to earlier identify the women at highest risk.…”

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confidence: 99%

High-Normal Estimated Glomerular Filtration Rate in Early-Onset Preeclamptic Women 10 Years Postpartum

et al. 2016

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Abstract-Women with a history of preeclampsia have a 5-to 12-fold increased risk to develop end-stage kidney disease.Previous observations in small cohorts suggest that former preeclamptic (fPE) women have subtle abnormalities in renal hemodynamics and renal function, which might predispose them to renal failure in later life. In this study, we analyzed renal function in a cross-sectional cohort consisting of former early-onset preeclamptic (fPE, n=339) and former healthy pregnant women (fHP, n=332), overall with a mean age of 39 years at 10 years postpartum. Estimated glomerular filtration rate (eGFR), assessed by the modification of diet in renal disease (MDRD) and chronic kidney disease-epidemiology (CKD-epi) equations, and urinary protein:creatinine ratios were assessed 10 years postpartum. Median MDRD and CKD-epi eGFR did not significantly differ between fHP and fPE groups, whereas a comparison of distribution of eGFR revealed a shift toward a high-normal MDRD eGFR in the fPE group (χ 2 , P=0.02) with the same trend for CKD-epi eGFR (χ 2 , P=0.18). The odds ratio for fPE women having MDRD eGFR >110 mL/min per 1.73 m 2 was 1.6 (1.1-2.4). In addition, the median urinary protein:creatinine ratio was slightly higher in fPE (8.5 versus 7.1 mg/mmol; P<0.01) and correlated positively with both MDRD and CKD-epi eGFR in fPE women. No increased incidence of CKD in fPE women was observed.In conclusion, we demonstrate subtle changes in renal function in former early-onset preeclamptic women 10 years postpartum, characterized by a high-normal eGFR and a slightly higher protein excretion. Whether these subtle differences predispose to or predict long-term renal function loss in fPE women remains to be investigated. Clinical Trial Registration-URL: http://www.trialregister.nl. Unique identifier: NTR2668.

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“…In critically ill patients, elevated suPAR and uric acid levels have been associated with acute kidney injury [18,28]. Interestingly, there are data indicating that elevated suPAR levels may be prognostic for chronic kidney disease [29], while the risk for kidney disease after a hypertensive disorder in pregnancy has been established previously [30]. On the other hand, it is not quite clear why uric acid is elevated in PE besides of maternal renal dysfunction, it could also be due to increased production or tissue ischemia and acidosis [31].…”

Section: Discussionmentioning

confidence: 99%

Serum Levels of Soluble Urokinase Plasminogen Activator Receptor Are Elevated in Severe Pre-Eclampsia

Jalkanen

Tihtonen

Jalkanen

et al. 2016

J Clin Gynecol Obstet

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Background: Soluble urokinase plasminogen activator receptor (suPAR) is a novel marker for systemic inflammation both in infectious and in inflammatory diseases. Since pathophysiology of preeclampsia has been found to include impairment of maternal immune system, we wanted to explore serum level of suPAR in women with severe pre-eclampsia and whether it differs from healthy pregnancies and non-pregnant women.Methods: Serum samples of suPAR concentrations were analyzed from 10 patients with severe pre-eclampsia, 10 patients with uncomplicated pregnancies and 10 non-pregnant women. SuPAR concentrations were analyzed with enzyme-linked immune-sorbent assay (ELISA).Results: SuPAR levels were significantly higher in pre-eclampsia 3.5 ng/mL (2.4 -4.8 ng/mL) compared to healthy pregnancy 2.0 ng/mL (1.7 -2.6 ng/mL) (P =0.008) or non-pregnant women 2.3 ng/mL (1.9 -2.9 ng/mL) (P = 0.015). Meanwhile, suPAR concentrations in healthy pregnant patients did not differ from non-pregnant women (P = 0.211). Conclusions:Serum suPAR levels are elevated in patients with severe pre-eclampsia implying that the systemic inflammatory response is enhanced in severe pre-eclampsia.

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End-stage Renal Disease After Hypertensive Disorders in Pregnancy

Cited by 16 publications

References 0 publications

Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study

Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study

High-Normal Estimated Glomerular Filtration Rate in Early-Onset Preeclamptic Women 10 Years Postpartum

Serum Levels of Soluble Urokinase Plasminogen Activator Receptor Are Elevated in Severe Pre-Eclampsia

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