End-stage renal disease after hypertensive disorders in pregnancy

• Published in: American journal of obstetrics and gynecology 2014-02, Vol.210 (2), p.147.e1-147.e8
• Main Authors: Wu, Chia-Chun, MD, Chen, Sheng-Hsien, MD, PhD, Ho, Chung-Han, PhD, Liang, Fu-Wen, PhD, Chu, Chin-Chen, MD, PhD, Wang, Hsien-Yi, MD, Lu, Yi-Hua, MD
• Format: Article
• Language: English
• Subjects: Adult; Female; Humans; Hypertension, Pregnancy-Induced; hypertensive disorder; Kaplan-Meier Estimate; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - etiology; Obstetrics and Gynecology; Pregnancy; Proportional Hazards Models; renal disease; Taiwan - epidemiology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.09.027

Objective The purpose of this study was to determine the long-term postpartum risk of end-stage renal disease in women with hypertensive disorders in pregnancy. Although most women with hypertensive disorders in pregnancy recover after delivery, some may experience acute renal failure. Study Design We searched Taiwan's National Health Insurance Research Database to identify women with hypertensive disorders in pregnancies and deliveries between 1998 and 2002. All cases were followed for a maximum of 11 years (median, 9 years; interquartile range, 7.79–10.02 years) to estimate the incidence of end-stage renal disease; Cox regression analysis that was adjusted for potential confounding was used to determine the relative risk. Results Of the 13,633 women with hypertensive disorders in pregnancy, 46 experienced end-stage renal disease. Women with hypertensive disorders in pregnancy had a risk of end-stage renal disease that was 10.64 times greater than did women without them (95% confidence interval [CI], 7.53–15.05). The risk was highest in women with a history of preeclampsia superimposed on chronic hypertension (hazard ratio, 44.72; 95% CI, 22.59–88.51). Women with gestational hypertension had a higher risk of end-stage renal disease than did women without hypertensive disorders in pregnancy (hazard ratio, 5.82; 95% CI, 2.15–15.77). Conclusion Women with hypertensive disorders in pregnancy have a higher risk of postpartum end-stage renal disease, regardless of which type of hypertensive disorder they have. Women with a history of hypertensive disorders in pregnancy are encouraged to have regular postpartum checkups, especially of renal function.