PMID- 32797043 OWN - NLM STAT- MEDLINE DCOM- 20200924 LR - 20240330 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 17 IP - 8 DP - 2020 Aug TI - Hypertensive disorders of pregnancy and the risk of chronic kidney disease: A Swedish registry-based cohort study. PG - e1003255 LID - 10.1371/journal.pmed.1003255 [doi] LID - e1003255 AB - BACKGROUND: Hypertensive disorders of pregnancy (HDP) (preeclampsia, gestational hypertension) are associated with an increased risk of end-stage kidney disease (ESKD). Evidence for associations between HDP and chronic kidney disease (CKD) is more limited and inconsistent. The underlying causes of CKD are wide-ranging, and HDP may have differential associations with various aetiologies of CKD. We aimed to measure associations between HDP and maternal CKD in women who have had at least one live birth and to identify whether the risk differs by CKD aetiology. METHODS AND FINDINGS: Using data from the Swedish Medical Birth Register (MBR), singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register (SRR) and National Patient Register (NPR; up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. Gestational hypertension was also investigated as a secondary exposure. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulointerstitial, and other/nonspecific CKD. Cox proportional hazard regression models were used, adjusting for maternal age, country of origin, education level, antenatal BMI, smoking during pregnancy, gestational diabetes, and parity. Women with pre-pregnancy comorbidities were excluded. The final sample consisted of 1,924,409 women who had 3,726,554 singleton live births. The mean (+/-SD) age of women at first delivery was 27.0 (+/-5.1) years. Median follow-up was 20.7 (interquartile range [IQR] 9.9-30.0) years. A total of 90,917 women (4.7%) were diagnosed with preeclampsia, 43,964 (2.3%) had gestational hypertension, and 18,477 (0.9%) developed CKD. Preeclampsia was associated with a higher risk of developing CKD during follow-up (adjusted hazard ratio [aHR] 1.92, 95% CI 1.83-2.03, p < 0.001). This risk differed by CKD subtype and was higher for hypertensive CKD (aHR 3.72, 95% CI 3.05-4.53, p < 0.001), diabetic CKD (aHR 3.94, 95% CI 3.38-4.60, p < 0.001), and glomerular/proteinuric CKD (aHR 2.06, 95% CI 1.88-2.26, p < 0.001). More modest associations were observed between preeclampsia and tubulointerstitial CKD (aHR 1.44, 95% CI 1.24-1.68, p < 0.001) or other/nonspecific CKD (aHR 1.51, 95% CI 1.38-1.65, p < 0.001). The risk of CKD was increased after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who had gestational hypertension also had increased risk of developing CKD (aHR 1.49, 95% CI 1.38-1.61, p < 0.001). This association was strongest for hypertensive CKD (aHR 3.13, 95% CI 2.47-3.97, p < 0.001). Limitations of the study are the possibility that cases of CKD were underdiagnosed in the national registers, and some women may have been too young to have developed symptomatic CKD despite the long follow-up time. Underreporting of postpartum hypertension is also possible. CONCLUSIONS: In this study, we found that HDP are associated with increased risk of maternal CKD, particularly hypertensive or diabetic forms of CKD. The risk is higher after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who experience HDP may benefit from future systematic renal monitoring. FAU - Barrett, Peter M AU - Barrett PM AUID- ORCID: 0000-0002-9637-9603 AD - School of Public Health, University College Cork, Cork, Ireland. AD - Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland. FAU - McCarthy, Fergus P AU - McCarthy FP AUID- ORCID: 0000-0001-5062-6851 AD - Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland. AD - Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland. FAU - Evans, Marie AU - Evans M AUID- ORCID: 0000-0001-8650-5795 AD - Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. FAU - Kublickas, Marius AU - Kublickas M AUID- ORCID: 0000-0002-1875-0745 AD - Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden. FAU - Perry, Ivan J AU - Perry IJ AD - School of Public Health, University College Cork, Cork, Ireland. FAU - Stenvinkel, Peter AU - Stenvinkel P AD - Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. FAU - Khashan, Ali S AU - Khashan AS AD - School of Public Health, University College Cork, Cork, Ireland. AD - Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland. FAU - Kublickiene, Karolina AU - Kublickiene K AD - Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - 203930/B/16/Z/WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200814 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Adult MH - Cohort Studies MH - Female MH - Follow-Up Studies MH - Humans MH - Hypertension, Pregnancy-Induced/*diagnosis/*epidemiology/physiopathology MH - Middle Aged MH - Pre-Eclampsia/diagnosis/epidemiology/physiopathology MH - Pregnancy MH - *Registries MH - Renal Insufficiency, Chronic/*diagnosis/*epidemiology/physiopathology MH - Risk Factors MH - Sweden/epidemiology MH - Young Adult PMC - PMC7428061 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: ME has participated in advisory board meetings (Astellas, Astra Zeneca, Vifor Pharma) and has received payment for lectures (Astellas, Vifor Pharma). EDAT- 2020/08/17 06:00 MHDA- 2020/09/25 06:00 PMCR- 2020/08/14 CRDT- 2020/08/16 06:00 PHST- 2020/03/02 00:00 [received] PHST- 2020/07/15 00:00 [accepted] PHST- 2020/08/16 06:00 [entrez] PHST- 2020/08/17 06:00 [pubmed] PHST- 2020/09/25 06:00 [medline] PHST- 2020/08/14 00:00 [pmc-release] AID - PMEDICINE-D-20-00714 [pii] AID - 10.1371/journal.pmed.1003255 [doi] PST - epublish SO - PLoS Med. 2020 Aug 14;17(8):e1003255. doi: 10.1371/journal.pmed.1003255. eCollection 2020 Aug.