Pregnant women with preeclampsia are at increased risk for chronic hypertension, reduced kidney function, and albuminuria, a new study finds.
Among 27,800 pregnant women, 2977 women (10.7%) had at least 1 pregnancy complicated by preeclampsia. Investigators propensity score matched approximately 4552 women with and without the condition for analysis. Women who experienced preeclampsia had higher rates of later developing chronic hypertension (15.3 vs 8.6 per 1000-person-years), an estimated glomerular filtration rate (eGFR; in mL/min/1.73 m2) less than 60 (1.9 vs 0.7 per 1000 person-years), and albuminuria of at least 300 mg/g (5.3 vs 1.6 per 1000 person-years). Preeclampsia was significantly associated with a 1.8-fold increased risk of developing chronic hypertension, a 3.2-fold risk of an eGFR less than 60, and a 3.6-fold risk of albuminuria, Nityasree Srialluri, MD, MS, of Johns Hopkins University in Baltimore, Maryland, and colleagues reported in the American Journal of Kidney Diseases. The risk for subsequent preeclampsia was 24.8-fold higher for women with vs without a first episode.
Postpartum follow-up testing was low, the investigators reported. In the first 6 months after delivery, 31% vs 14% of women with and without preeclampsia had serum creatinine tests, respectively, and 26% in each group had albuminuria testing.
“Taken together, our findings suggest that individuals who develop preeclampsia during pregnancy constitute a high-risk population for kidney disease and merit closer monitoring for early prevention of long-term consequences,” Dr Srialluri’s wrote.
US guidelines have not specifically addressed kidney function monitoring after preeclampsia. The investigators noted that in the UK, the National Institute for Health and Care Excellence has advised urine protein measurement 6-8 weeks after delivery and primary care or specialists follow-up at 3 months for persistent proteinuria.
A 2019 observational study by Ali S. Khashan, PhD, of University College Cork in Cork, Ireland, and colleagues published in PLoS Medicine found that preeclampsia was significantly associated with a 5-fold increased risk for end-stage kidney disease. Women with preterm preeclampsia or preeclampsia in 2 pregnancies appeared to have the highest risks.
Srialluri N, Surapaneni A, Chang A, Mackeen AD, Paglia MJ, Grams ME. Preeclampsia and long-term kidney outcomes. Am J Kidney Dis. Published online July 27, 2023. doi:10.1053/j.ajkd.2023.04.010
Khashan AS, Evans M, Kublickas M, et al. Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLoS Med. 2019;16(7):e1002875. doi:10.1371/journal.pmed.1002875