OP 6 The association between pre-eclampsia and the risk of kidney disease – A nationwide cohort study

Abstract

Introduction Studies on the association between pre-eclampsia and the risk of kidney disease in the women are limited. Objectives To examine the association between pre-eclampsia and the risk of end stage renal disease (ESRD) chronic kidney disease (CKD) after delivery. Patients and methods Using data from the Swedish Medical Birth Register, women who had singleton live birth in Sweden between January 1, 1982 and December 31, 2012 were identified. Pre-eclampsia, ESRD and CKD diagnoses based on the International Classification of Diseases, eighth, ninth and tenth revision were identified from the Swedish Medical Birth Register and the Swedish National Hospital Register respectively. We conducted Cox proportional hazards regression analysis to examine the association between pre-eclampsia and ESRD and CKD adjusting for several potential confounders including maternal age, body mass index, smoking, parity, country of birth, pre-pregnancy diabetes, pre-pregnancy hypertension, small for gestational age and large for gestational age. Results The study cohort consisted of 1,433,123 women giving birth to 2,789,313 singleton live babies in Sweden between January 1, 1982 and December 31, 2012. During the study period, 59,583 (4.2%) women having 82,591 singleton live births had pre-eclampsia, 1606 women (3134 pregnancies) had ESRD and 19,421 (32,049 pregnancies) had CKD. Including the entire study cohort, the findings supported an association between pre-eclampsia and ESRD in the crude (HR = 5.02, [95% CIs: 2.42–3.82]) and adjusted (HR = 2.72, [95% CIs: 2.34–3.20]) models and CKD in the crude (HR = 1.41; [95% CIs: 1.35–1.47]) and adjusted (HR = 1.44; [95% CIs: 1.38–1.50]) models. Women who had two pregnancies with pre-eclampsia had a 10-fold increased risk of ESRD in the crude analysis (HR = 10.13; [95% CIs: 6.76, 15.19]) and 3-fold increased risk of ESRD in the adjusted analysis (HR = 2.98; [95% CIs: 1.89, 4.70]). Conclusion The present findings suggest that women with pre-eclampsia are at 2 to 3-fold increased risk of ESRD and 40% increased risk of CKD compared to parous women with no pre-eclampsia. The association was significant across a range of subgroup analyses.