Hypertension during pregnancy linked to CKD

Women with hypertensive disorders during pregnancy are at higher risk of chronic kidney disease and end-stage renal disease compared with women without the disorders, according to a study based in Taiwan.

Hypertensive disorders such as gestational hypertension and preeclampsia during pregnancy can have a major impact on the health of the mother and baby and are risk factors for death, according to background information in the study, which is scheduled for publication in the Canadian Medical Association Journal. An estimated 5% to 10% of pregnancies are affected by hypertensive disorders. Kidney function can be affected.

Taiwanese researchers looked at data on 26,651 women in Taiwan with hypertensive disorders in their first pregnancy to determine whether they had an increased risk of end-stage renal disease compared with a group of 213,397 women without such disorders. The women were ages 19 to 40 and did not have a history of hypertension, diabetes or kidney disease.

The incidence of chronic kidney disease was almost 11-fold higher in the group with hypertensive disorders during pregnancy compared with the women without the disorders. End-stage renal disease was 14-fold higher in the cohort with hypertensive disorders. The risk for women with preeclampsia was higher than for those who had gestational hypertension.

There has been little data on the link between hypertensive disorders during pregnancy and the risk of end-stage renal disease. This study is consistent with a Norwegian study that found a similar link between these disorders and later kidney disease, the researchers said.

“Close surveillance for microalbuminuria, blood pressure and diabetes should be considered for women with a history of hypertensive disorders during pregnancy,” the authors wrote. “Preventive strategies, such as pharmacologic or lifestyle interventions, should also be considered for women at high risk of end-stage renal disease.”

In a related commentary, Julia Spaan, MD, PhD, of Maastricht University in the Netherlands, and Mark Brown, MD, of the University of New South Wales in Australia, wrote that the study “shows the importance of hypertension during pregnancy as a marker for future chronic kidney disease, cardiovascular disease and diabetes.

“It also highlights one of the current pitfalls of clinical practice: Although these women have great attention paid to their high blood pressure during pregnancy, there is no structured follow-up of blood pressure or of cardiovascular and renal risk factors after pregnancy. Better surveillance after pregnancy should help prevent not only chronic kidney disease but also cardiovascular disease.”

A PDF of the study is available at www.cmaj.ca/content/early/2013/01/21/cmaj.120230.

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