TY - JOUR
T1 - Kidney Function After a Hypertensive Disorder of Pregnancy
T2 - A Longitudinal Study
AU - Paauw, Nina D.
AU - van der Graaf, Anne Marijn
AU - Bozoglan, Rita
AU - van der Ham, David P.
AU - Navis, Gerjan
AU - Gansevoort, Ron T.
AU - Groen, Henk
AU - Lely, A. Titia
N1 - Funding Information:
Support: The PREVEND Study was supported by the Dutch Kidney Foundation (grant E.033 ) and The Groningen University Medical Center (Beleidsruimte), as well as Dade Behring, AusAm biotechnologies, Roche, Abbott, and Gentian, which financed laboratory equipment and reagents for various laboratory determinations. This subanalysis was also supported by a ZonMw Clinical Fellowship (project no. 40-000703-97-12463) to Dr Lely. The funders had no role in interpretation and reporting of the data or in the decision to submit the report for publication.
Funding Information:
Support: The PREVEND Study was supported by the Dutch Kidney Foundation (grant E.033) and The Groningen University Medical Center (Beleidsruimte), as well as Dade Behring, AusAm biotechnologies, Roche, Abbott, and Gentian, which financed laboratory equipment and reagents for various laboratory determinations. This subanalysis was also supported by a ZonMw Clinical Fellowship (project no. 40-000703-97-12463) to Dr Lely. The funders had no role in interpretation and reporting of the data or in the decision to submit the report for publication.
Publisher Copyright:
© 2017
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: Registry-based studies report an increased risk for end-stage kidney disease after hypertensive disorders of pregnancy (HDPs). It is unclear whether HDPs lead to an increased incidence of chronic kidney disease (CKD) and/or progression of kidney function decline. Study Design: Subanalysis of the Prevention of Renal and Vascular Endstage Disease (PREVEND) Study, a Dutch population-based cohort with follow-up of 5 visits approximately 3 years apart. Setting & Participants: Women without and with patient-reported HDPs (non-HDP, n = 1,805; HDP, n = 977) were identified. Mean age was 50 years at baseline and median follow-up was 11 years. Factor: An HDP. Outcomes: (1) The incidence of CKD using Cox regression and (2) the course of kidney function (estimated glomerular filtration rate [eGFR] and 24-hour albuminuria) over 5 visits using generalized estimating equation analysis adjusted for age, mean arterial pressure, and renin-angiotensin system (RAS) blockade. CKD was defined as eGFR < 60 mL/min/1.73 m2 and/or 24-hour albuminuria with albumin excretion > 30 mg, and end-stage kidney disease was defined as receiving dialysis or kidney transplantation. Results: During follow-up, none of the women developed end-stage renal disease and the incidence of CKD during follow-up was similar across HDP groups (HR, 1.04; 95% CI, 0.79-1.37; P = 0.8). Use of RAS blockade was higher after HDP at all visits. During a median of 11 years, we observed a decrease in eGFR in both groups, with a slightly steeper decline in the HDP group (98 ± 15 to 88 ± 16 vs 99 ± 17 to 91 ± 15 mL/min/1.73 m2; Pgroup < 0.01, Pgroup*visit < 0.05). The group effect remained significant after adjusting for mean arterial pressure, but disappeared after adjusting for RAS blockade. The 24-hour albuminuria did not differ between groups. Limitations: No obstetric records available. HDPs defined by patient report rather than health records. Conclusions: HDPs did not detectably increase the incidence of CKD. During follow-up, we observed no differences in albuminuria, but observed a marginally lower eGFR after HDP that was no longer statistically significant after adjusting for the use of RAS blockers. In this population, we were unable to identify a significant risk for kidney function decline after patient-reported HDP.
AB - Background: Registry-based studies report an increased risk for end-stage kidney disease after hypertensive disorders of pregnancy (HDPs). It is unclear whether HDPs lead to an increased incidence of chronic kidney disease (CKD) and/or progression of kidney function decline. Study Design: Subanalysis of the Prevention of Renal and Vascular Endstage Disease (PREVEND) Study, a Dutch population-based cohort with follow-up of 5 visits approximately 3 years apart. Setting & Participants: Women without and with patient-reported HDPs (non-HDP, n = 1,805; HDP, n = 977) were identified. Mean age was 50 years at baseline and median follow-up was 11 years. Factor: An HDP. Outcomes: (1) The incidence of CKD using Cox regression and (2) the course of kidney function (estimated glomerular filtration rate [eGFR] and 24-hour albuminuria) over 5 visits using generalized estimating equation analysis adjusted for age, mean arterial pressure, and renin-angiotensin system (RAS) blockade. CKD was defined as eGFR < 60 mL/min/1.73 m2 and/or 24-hour albuminuria with albumin excretion > 30 mg, and end-stage kidney disease was defined as receiving dialysis or kidney transplantation. Results: During follow-up, none of the women developed end-stage renal disease and the incidence of CKD during follow-up was similar across HDP groups (HR, 1.04; 95% CI, 0.79-1.37; P = 0.8). Use of RAS blockade was higher after HDP at all visits. During a median of 11 years, we observed a decrease in eGFR in both groups, with a slightly steeper decline in the HDP group (98 ± 15 to 88 ± 16 vs 99 ± 17 to 91 ± 15 mL/min/1.73 m2; Pgroup < 0.01, Pgroup*visit < 0.05). The group effect remained significant after adjusting for mean arterial pressure, but disappeared after adjusting for RAS blockade. The 24-hour albuminuria did not differ between groups. Limitations: No obstetric records available. HDPs defined by patient report rather than health records. Conclusions: HDPs did not detectably increase the incidence of CKD. During follow-up, we observed no differences in albuminuria, but observed a marginally lower eGFR after HDP that was no longer statistically significant after adjusting for the use of RAS blockers. In this population, we were unable to identify a significant risk for kidney function decline after patient-reported HDP.
KW - Albuminuria
KW - blood pressure
KW - chronic kidney disease (CKD)
KW - end-stage kidney disease (ESKD)
KW - gestational hypertension
KW - hypertension
KW - hypertensive disorders of pregnancy
KW - kidney function
KW - preeclampsia
KW - proteinuria
UR - http://www.scopus.com/inward/record.url?scp=85042366040&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2017.10.014
DO - 10.1053/j.ajkd.2017.10.014
M3 - Article
C2 - 29289477
SN - 0272-6386
VL - 71
SP - 619
EP - 626
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -