Kidney Function After a Hypertensive Disorder of Pregnancy: A Longitudinal Study

Abstract

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.