Increasing incidence of hypertensive disorders of pregnancy and association with decreased GFR and albuminuria: The need for post-partum follow-up

Abstract

Background

Hypertensive disorders of pregnancy (HDP) are associated with increased postpartum risk of cardiovascular disease or kidney failure. However, there is scarce information on the association with actionable kidney outcomes that should be treated to prevent progression to kidney failure.

Objectives

To evaluate the incidence of HDP over time and its association with kidney function, hypertension, and albuminuria during follow-up after discharge.

Methods

Single center retrospective cohort study of women without previous history of CKD among 20484 deliveries over 10 years.

Results

From 2008 to 2017, HDP was diagnosed in 846 (4.13 %) pregnant women. The incidence increased over time and was higher in women from Africa and America than in European women. The Nephrology department evaluated 210 (27 %) women with HDP during hospitalization and 170 (21 %) during follow-up. At follow-up, 5.3 % of the 150 women with available follow-up eGFR data had decreased eGFR (<90 ml/min/1.73 m²), 16.1 % albuminuria ≥30 mg/g and 8.6 % persistent hypertension. In multivariate analysis, gestational diabetes mellitus [OR 8.03 (95 % CI: 1.49–43.13; p 0.01)] and higher number of pregnancies [OR: 1.27 (95 % CI: 1.00–1.62; p 0.04)] were associated with persistent hypertension; diabetes mellitus [OR 14.07 (1.59–123.89); p = 0.02] with decreased glomerular filtration rate; and obesity [OR: 5.79 (1.70–19.13); p = 0.004] and diabetes mellitus [OR 5.86 (1.18–29.09); p = 0.03] with persistent albuminuria. Kaplan Meier analysis was consistent with a higher risk of decreased eGFR within 12 months for patients with albuminuria ≥30 mg/g (p = 0.02, logRank Test).

Conclusion

The incidence of HDP is increasing but most patients with HDP lack outpatient follow-up. In those with nephrological follow-up, decreased eGFR, evidence of CKD or residual hypertension are common. Metabolic conditions (obesity, diabetes mellitus) may identify those at higher risk of actionable short-term adverse kidney outcomes.