Women with pre-eclampsia during pregnancy have a five-fold increased risk of end stage kidney disease (ESKD) later in life compared to women who don't develop pre-eclampsia during pregnancy, according to a new study published this week in PLOS Medicine by Ali Khashan of University College Cork, Ireland, and colleagues at the Karolinska Institute, Sweden and Liverpool University, UK.
As the prevalence of kidney disease has risen over recent years, it has become clear that more women have pre-dialysis kidney disease than men. Reproductive history, including the development of pre-eclampsia during pregnancy, has been hypothesized to play a role. In the new study, researchers analyzed data from the Swedish Medical Birth Register on 1,366,441 healthy women with 2,665,320 singleton live births in Sweden between 1982 and 2012.
The data revealed that women who had pre-eclampsia in at least one pregnancy were nearly five times more likely to have ESKD than women who had never had pre-eclampsia (hazard ratio 4.96; 95%CI 3.89-6.32). The incidence rate of ESKD per 100,000 person-years was 1.85 (95%CI 1.66-2.05) among women with no history of pre-eclampsia and 12.35 (95%CI 9.61-15.88) among women with a history of pre-eclampsia. Moreover, the association was independent of other factors including maternal age and education, and diagnoses of renal disease or cardiovascular disease before pregnancy.
The new paper "shows that pre-eclampsia is a sex-specific, independent risk factor for the subsequent development of ESKD," the authors say. "However, it should be noted that the overall ESKD risk remains small. Whether screening or preventative strategies will reduce the risk of ESKD in women with adverse pregnancy outcomes is worthy of further investigation."
The study was partly funded by the Irish Centre for Fetal and Neonatal Translational Research (INFANT) (grant no. 12/RC/2272), Strategic Research Programme in Diabetes at Karolinska Institutet (Swedish Research Council grant No 2009-1068), the Stockholm County Council (ALF), and the Swedish Kidney Foundation. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
I have read the journal's policy and the authors of this manuscript have the following competing interests: ME has participated in an advisory board meeting (Astellas) and has received payment for lectures by Astellas in the field of renal anemia. LCK is a minority shareholder in Metabolomic Diagnostics, a company which has licenced IP pertaining to the early pregnancy prediction of biomarkers to predict pre-eclampsia. LCK has also given talks about pre-eclampsia at symposia sponsored by Roche and Alere.
Khashan AS, Evans M, Kublickas M, McCarthy FP, Kenny LC, Stenvinkel P, et al. (2019) Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLoS Med 16(7): e1002875. https:/
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School of Public Health, University College Cork, Cork, Ireland, 2 The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
Renal Medicine, Department of Clinical intervention, Science and Technology (CLINTEC), Karolinska Institutet and Karolinska University hospital, Stockholm, Sweden
Department of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University hospital Stockholm, Sweden
Division of Women's Health, Women's Health Academic Centre KHP, St. Thomas' Hospital, London, United Kingdom
Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
Department of Statistics, University College Cork, Cork, Ireland
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