Hypertensive disorders of pregnancy associated with future renal disease

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1. Women with any hypertensive disorder of pregnancy were ten times more likely to develop future end-stage renal disease (ESRD). 

2. Incidence of future ESRD increased with severity of hypertensive disorder of pregnancy on a scale ranging from gestational hypertension to pre-eclampsia to super-imposed pre-eclampsia on chronic hypertension (highest incidence). 

Evidence Rating Level: 2 (Good) 

Study Rundown: This study found that women with hypertensive disorders during pregnancy were more than ten times as likely to develop future ESRD. Moreover, risk increased with the severity of the hypertensive disease such that gestational hypertension was associated with a five times greater incidence while superimposed pre-eclampsia was associated with a 44 times greater incidence.

This is one of the first studies to look at the association of hypertensive disorders of pregnancy with long-term renal outcomes. This study is large, includes a nationwide cohort but may be limited in generalizability due to use of a solely Taiwanese population. Reproduction of results with longer follow-up in a diverse patient population is merited.

Click to read the study in AJOG

Relevant Reading: Uptodate: Management of hypertension in pregnant and postpartum women

Study Author, Dr. Chia-Chun Wu, MD, talks to 2 Minute Medicine: Department of Nephrology, Chi Mei Medical Center, Taiwan

“Our study shows that the full range of hypertensive disorders of pregnancy (HDPs) may increase risk for end stage renal disease later in life. HDP is not just a transient illness, but may have delayed onset complications. Physicians of all specialties should understand HDPs and promote those with a history of HDPs to get adequate follow-up throughout life.”

In-Depth [retrospective cohort]: This study used a Taiwanese nationwide database to identify 944,474 women who delivered from 1998-2002, of which 13,633 had a hypertensive disorder of pregnancy (cases). Cases were stratified by disorder type: gestational hypertensives (n=2,361), pre-eclamptic and eclamptics (n=8,609), and superimposed pre-eclamptics (n=594). Primary outfcome was incidence of ESRD during follow-up (median=9 years).

Women with any hypertensive disorder of pregnancy were over 10 times as likely to develop ESRD (95% CI=7.3-15.05). Gestational hypertension (HR=5.82, CI=2.15-15.77), preeclampsia/eclampsia (HR=9.46, CI=6.10-14.68), and superimposed preeclampsia (HR=44.72, CI=22.59-88.51) were associated with increased future development of ESRD.

By Maren Shapiro and Leah Hawkins, MD, MPH

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