Adverse pregnancy outcomes tied to long-term kidney disease risk in women

  • Barrett PM & al.
  • JAMA Netw Open
  • 5 Feb 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Women who experience adverse pregnancy outcomes, including hypertensive disorders of pregnancy (HDP), gestational diabetes and pre-term delivery, may be at an increased risk for future chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
  • ESKD risk was highest among women who experienced preeclampsia.

Why this matters

  • Women with HDP and other adverse pregnancy outcomes may warrant closer surveillance for long-term kidney disease.

Study design

  • 23 studies (n=5,769,891) met eligibility criteria after a search across PubMed, Embase, and Web of Science.
  • Primary outcomes: CKD and ESKD diagnosis.
  • Funding: The Wellcome Trust and the Health Research Board and others.

Key results

  • Pre-eclampsia was associated with a significantly increased risk for:
    • CKD (adjusted risk ratio [aRR], 2.11; 95% CI, 1.72-2.59);
    • ESKD (aRR, 4.90; 95% CI, 3.56-6.74; I2=73%); and
    • kidney-related hospitalisation (aRR, 2.65; 95% CI, 1.03-6.77; I2=92%).
  • Women with gestational hypertension were at an increased risk for:
    • CKD (aRR, 1.49; 95% CI, 1.11-2.01) and
    • ESKD (aRR, 3.64; 95% CI, 2.34-5.66).
  • Pre-term pre-eclampsia was associated with an increased risk for ESKD (aRR, 5.66; 95% CI, 3.06-10.48; I2=59%).
  • Women with pre-term deliveries, without pre-eclampsia, were at a higher risk for ESKD (aRR, 2.09; 95% CI, 1.64-2.66).
  • Gestational diabetes tied to an increased risk for CKD in black women (aRR, 1.78; 95% CI, 1.18-2.70) but not in white women (aRR, 0.81; 95% CI, 0.58-1.13).

Limitations

  • Heterogeneity among studies.