The association of hypertensive disorders in pregnancy with future end-stage renal disease

(1)

China Medical University Hospital

The association of hypertensive disorders in pregnancy with future end-stage renal disease I-Kuan Wang, MD1, 2,_{, Chih-Hsin Muo, MSPH}3_{, Chih-Chia Liang, MD}1_{, Chiz-Tzung Chang, PhD}2_,

Chiu-Ching Huang, MD1_{, Fung-Chang Sung, PhD, MPH}3

1_{Division of Nephrology, China Medical University Hospital;}2_{Department of Internal Medicine,}

College of Medicine, China Medical University, Taichung, Taiwan; 3_{Management Office for Health}

Data, China Medical University Hospital

Abstract

Background

Studies on the association between hypertensive disorders in pregnancy (HDP) and end stage renal disease (ESRD) are limited. This study investigated the ESRD risk for women after delivery with HDP.

Methods

We used insurance claims data to identify 26,651 women aged 19-40 years old with the history of HDP in 1998-2009, without the baseline history of hypertension, diabetes, kidney disease, or lupus. Frequency matched with age and index year of the HDP women, and

213,397 non-HDP women were randomly selected. Incidence rates of ESRD were compared between the two cohorts. Hazard ratios (HRs) were calculated controlling for demographics and clinical factors. .

Results

Seventy-nine women in the HDP cohort and 45 women in the non-HDP cohort developed

ESRD. The incidence was 13.9-fold greater in the HDP cohort than in the non-HDP cohort (4.72 vs. 0.34 per 10000 person-years), with an adjusted HR of 12.4 (95% CI 8.54-18.0) after controlling for urbanization, coronary artery disease, congestive heart failure,

hyperlipidemia and abruption. The HR was reduced to 2.72 (95% CI 1.76-4.22) after further controlling for hypertension and diabetes.(Table 2) The incidence of ESRD was elevated for women with recurrent HDP. HDP women with preeclampsia/eclampsia were at higher risk (adjusted HR 14.0, 95% CI 9.43-20.7) than those with only gestational hypertension

(adjusted HR 9.03, 95% CI 5.20-15.7).

Conclusions.

Women with HDP are at a high risk of subsequent ESRD. The incidence of ESRD may increase further for women with recurrent HDP.