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- Title
Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study.
- Authors
Khashan, Ali S.; Evans, Marie; Kublickas, Marius; McCarthy, Fergus P.; Kenny, Louise C.; Stenvinkel, Peter; Fitzgerald, Tony; Kublickiene, Karolina
- Abstract
Background: Preeclampsia has been suggested to increase the risk of end-stage kidney disease (ESKD); however, most studies were unable to adjust for potential confounders including pre-existing comorbidities such as renal disease and cardiovascular disease (CVD). We aimed to examine the association between preeclampsia and the risk of ESKD in healthy women, while taking into account pre-existing comorbidity and potential confounders. Methods and findings: Using data from the Swedish Medical Birth Register (MBR), women who had singleton live births in Sweden between 1982 and 2012, including those who had preeclampsia, were identified. Women with a diagnosis of chronic kidney disease (CKD), CVD, hypertension, or diabetes prior to the first pregnancy were excluded. The outcome was a diagnosis of ESKD, identified from the Swedish Renal Registry (SRR) from January 1, 1991, onwards along with the specified cause of renal disease. We conducted Cox proportional hazards regression analysis to examine the association between preeclampsia and ESKD adjusting for several potential confounders: maternal age, body mass index (BMI), education, native country, and smoking. This analysis accounts for differential follow-up among women because women had different lengths of follow-up time. We performed subgroup analyses according to preterm preeclampsia, small for gestational age (SGA), and women who had 2 pregnancies with preeclampsia in both. The cohort consisted of 1,366,441 healthy women who had 2,665,320 singleton live births in Sweden between 1982 and 2012. At the first pregnancy, women's mean (SD) age and BMI were 27.8 (5.13) and 23.4 (4.03), respectively, 15.2% were smokers, and 80.7% were native Swedish. The overall median (interquartile range [IQR]) follow-up was 7.4 years (3.2–17.4) and 16.4 years (10.3–22.0) among women with ESKD diagnosis. During the study period, 67,273 (4.9%) women having 74,648 (2.8% of all pregnancies) singleton live births had preeclampsia, and 410 women developed ESKD with an incidence rate of 1.85 per 100,000 person-years. There was an association between preeclampsia and ESKD in the unadjusted analysis (hazard ratio [HR] = 4.99, 95% confidence interval [CI] 3.93–6.33; p < 0.001), which remained in the extensively adjusted (HR = 4.96, 95% CI 3.89–6.32, p < 0.001) models. Women who had preterm preeclampsia (adjusted HR = 9.19; 95% CI 5.16–15.61, p < 0.001) and women who had preeclampsia in 2 pregnancies (adjusted HR = 7.13, 95% CI 3.12–16.31, p < 0.001) had the highest risk of ESKD compared with women with no preeclampsia. Considering this was an observational cohort study, and although we accounted for several potential confounders, residual confounding cannot be ruled out. Conclusions: The present findings suggest that women with preeclampsia and no major comorbidities before their first pregnancy are at a 5-fold increased risk of ESKD compared with parous women with no preeclampsia; however, the absolute risk of ESKD among women with preeclampsia remains small. Preeclampsia should be considered as an important risk factor for subsequent ESKD. Whether screening and/or preventive strategies will reduce the risk of ESKD in women with adverse pregnancy outcomes is worthy of further investigation. Ali S Khashan and colleagues reveal an increased risk for kidney disease in women who had pre-eclampsia during pregnancy. Author summary: Why was this study done?: A large number of studies reported an increased risk of cardiovascular disease (CVD) among women who had preeclampsia compared with women who had no preeclampsia. Only few studies reported such as association between preeclampsia and the risk of developing end-stage kidney disease (ESKD). Some of these studies did not adjust for key potential confounders and may have lacked high-quality data. What did the researchers do and find?: We performed this study to examine the association between preeclampsia and ESKD using a large cohort from the Swedish national registers (N = 1,366,441 healthy women who had 2,665,320 singleton live births). We found that women who had preeclampsia in at least one pregnancy, were 5 times more likely to have ESKD compared with parous women who had never had preeclampsia (hazard ratio [HR] = 4.96, 95% confidence interval [CI] 3.89–6.32). This association was independent of several sociodemographic factors such as maternal age and education and prepregnancy comorbidity such as renal disease and CVD. What do these findings mean?: These results highlight the importance of preeclampsia as a risk marker for developing ESKD. These findings need to be investigated further to see whether preventive strategies would reduce the risk of ESKD.
- Subjects
SWEDEN; PREECLAMPSIA; KIDNEY diseases; CARDIOVASCULAR diseases; SMALL for gestational age; DISEASE risk factors; CHRONIC kidney failure
- Publication
PLoS Medicine, 2019, Vol 16, Issue 7, p1
- ISSN
1549-1277
- Publication type
Article
- DOI
10.1371/journal.pmed.1002875