Pre-eclampsia and risk of later kidney disease: nationwide cohort study

ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing...

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Published in:BMJ (Online) 2019-04, Vol.365, p.l1516-l1516
Main Authors: Kristensen, Jonas H, Basit, Saima, Wohlfahrt, Jan, Damholt, Mette Brimnes, Boyd, Heather A
Format: Article
Language:English
Subjects:
Adult
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - complications
Cardiovascular Diseases - epidemiology
Cohort analysis
Denmark - epidemiology
Diabetes
Female
Gestational Age
Humans
Hypertension
Hypertension - complications
Hypertension - epidemiology
Hypertension, Renal - complications
Hypertension, Renal - epidemiology
Kidney diseases
Kidney Diseases - diagnosis
Kidney Diseases - epidemiology
Kidney Diseases - etiology
Medical research
Monitoring, Physiologic - standards
Population studies
Postpartum Period
Pre-eclampsia
Pre-Eclampsia - diagnosis
Pre-Eclampsia - epidemiology
Preeclampsia
Pregnancy
Public health
Risk Factors
Womens health
Young Adult
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creator Kristensen, Jonas H
Basit, Saima
Wohlfahrt, Jan
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Boyd, Heather A
description ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery
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Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery &lt;34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.</description><identifier>ISSN: 0959-8138</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.l1516</identifier><identifier>PMID: 31036557</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - epidemiology ; Cohort analysis ; Denmark - epidemiology ; Diabetes ; Female ; Gestational Age ; Humans ; Hypertension ; Hypertension - complications ; Hypertension - epidemiology ; Hypertension, Renal - complications ; Hypertension, Renal - epidemiology ; Kidney diseases ; Kidney Diseases - diagnosis ; Kidney Diseases - epidemiology ; Kidney Diseases - etiology ; Medical research ; Monitoring, Physiologic - standards ; Population studies ; Postpartum Period ; Pre-eclampsia ; Pre-Eclampsia - diagnosis ; Pre-Eclampsia - epidemiology ; Preeclampsia ; Pregnancy ; Public health ; Risk Factors ; Womens health ; Young Adult</subject><ispartof>BMJ (Online), 2019-04, Vol.365, p.l1516-l1516</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2019 BMJ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2019 BMJ</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b498t-81772ef31c08c8bf35cd81ad67a1f6fc18d3868d86e3a36300368eef00f5131f3</citedby><cites>FETCH-LOGICAL-b498t-81772ef31c08c8bf35cd81ad67a1f6fc18d3868d86e3a36300368eef00f5131f3</cites><orcidid>0000-0001-6849-9985</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmj.com/content/365/bmj.l1516.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmj.com/content/365/bmj.l1516.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,780,784,885,3192,27922,27923,77364,77365</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31036557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kristensen, Jonas H</creatorcontrib><creatorcontrib>Basit, Saima</creatorcontrib><creatorcontrib>Wohlfahrt, Jan</creatorcontrib><creatorcontrib>Damholt, Mette Brimnes</creatorcontrib><creatorcontrib>Boyd, Heather A</creatorcontrib><title>Pre-eclampsia and risk of later kidney disease: nationwide cohort study</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery &lt;34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.</description><subject>Adult</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - complications</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cohort analysis</subject><subject>Denmark - epidemiology</subject><subject>Diabetes</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - complications</subject><subject>Hypertension - epidemiology</subject><subject>Hypertension, Renal - complications</subject><subject>Hypertension, Renal - epidemiology</subject><subject>Kidney diseases</subject><subject>Kidney Diseases - diagnosis</subject><subject>Kidney Diseases - epidemiology</subject><subject>Kidney Diseases - etiology</subject><subject>Medical research</subject><subject>Monitoring, Physiologic - standards</subject><subject>Population studies</subject><subject>Postpartum Period</subject><subject>Pre-eclampsia</subject><subject>Pre-Eclampsia - diagnosis</subject><subject>Pre-Eclampsia - epidemiology</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Public health</subject><subject>Risk Factors</subject><subject>Womens health</subject><subject>Young Adult</subject><issn>0959-8138</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><recordid>eNp10U9rFDEYBvAgFbu0PfgFJNAe6mFqMtkk73oQSrF_oKAHPYds8sZmOzPZJjPKfnuz3Vqs4CmH_PLwhIeQt5ydcS7Uh2W_Ouu45OoVmXEtVcNBiD0yYwu5aIAL2CdHpawYY63QsFDyDdkXnAklpZ6Rq68ZG3Sd7dclWmoHT3Ms9zQF2tkRM72PfsAN9bGgLfiRDnaMafgVPVKX7lIeaRknvzkkr4PtCh49nQfk--XnbxfXze2Xq5uL89tmOV_AWPto3WIQ3DFwsAxCOg_ceqUtDyo4Dl6AAg8KhRVKsNoTEANjQXLBgzggn3a562nZo3c4jNl2Zp1jb_PGJBvNy5sh3pkf6adRc9BKyxpw-hSQ08OEZTR9LA67zg6YpmLalus5MNBQ6fE_dJWmPNTvbZVSSmvZVvV-p1xOpWQMz2U4M9uFTF3IPC5U7bu_2z_LP3tUcLID2zf_z_kNGYWXtQ</recordid><startdate>20190429</startdate><enddate>20190429</enddate><creator>Kristensen, Jonas H</creator><creator>Basit, Saima</creator><creator>Wohlfahrt, Jan</creator><creator>Damholt, Mette Brimnes</creator><creator>Boyd, Heather A</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6849-9985</orcidid></search><sort><creationdate>20190429</creationdate><title>Pre-eclampsia and risk of later kidney disease: nationwide cohort study</title><author>Kristensen, Jonas H ; Basit, Saima ; Wohlfahrt, Jan ; Damholt, Mette Brimnes ; Boyd, Heather A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b498t-81772ef31c08c8bf35cd81ad67a1f6fc18d3868d86e3a36300368eef00f5131f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - complications</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cohort analysis</topic><topic>Denmark - epidemiology</topic><topic>Diabetes</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - complications</topic><topic>Hypertension - epidemiology</topic><topic>Hypertension, Renal - complications</topic><topic>Hypertension, Renal - epidemiology</topic><topic>Kidney diseases</topic><topic>Kidney Diseases - diagnosis</topic><topic>Kidney Diseases - epidemiology</topic><topic>Kidney Diseases - etiology</topic><topic>Medical research</topic><topic>Monitoring, Physiologic - standards</topic><topic>Population studies</topic><topic>Postpartum Period</topic><topic>Pre-eclampsia</topic><topic>Pre-Eclampsia - diagnosis</topic><topic>Pre-Eclampsia - epidemiology</topic><topic>Preeclampsia</topic><topic>Pregnancy</topic><topic>Public health</topic><topic>Risk Factors</topic><topic>Womens health</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kristensen, Jonas H</creatorcontrib><creatorcontrib>Basit, Saima</creatorcontrib><creatorcontrib>Wohlfahrt, Jan</creatorcontrib><creatorcontrib>Damholt, Mette Brimnes</creatorcontrib><creatorcontrib>Boyd, Heather A</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Biological Sciences</collection><collection>ProQuest research library</collection><collection>ProQuest Science Journals</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kristensen, Jonas H</au><au>Basit, Saima</au><au>Wohlfahrt, Jan</au><au>Damholt, Mette Brimnes</au><au>Boyd, Heather A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-eclampsia and risk of later kidney disease: nationwide cohort study</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2019-04-29</date><risdate>2019</risdate><volume>365</volume><spage>l1516</spage><epage>l1516</epage><pages>l1516-l1516</pages><issn>0959-8138</issn><eissn>1756-1833</eissn><abstract>ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery &lt;34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>31036557</pmid><doi>10.1136/bmj.l1516</doi><orcidid>https://orcid.org/0000-0001-6849-9985</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - complications
Cardiovascular Diseases - epidemiology
Cohort analysis
Denmark - epidemiology
Diabetes
Female
Gestational Age
Humans
Hypertension
Hypertension - complications
Hypertension - epidemiology
Hypertension, Renal - complications
Hypertension, Renal - epidemiology
Kidney diseases
Kidney Diseases - diagnosis
Kidney Diseases - epidemiology
Kidney Diseases - etiology
Medical research
Monitoring, Physiologic - standards
Population studies
Postpartum Period
Pre-eclampsia
Pre-Eclampsia - diagnosis
Pre-Eclampsia - epidemiology
Preeclampsia
Pregnancy
Public health
Risk Factors
Womens health
Young Adult
title Pre-eclampsia and risk of later kidney disease: nationwide cohort study
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