Research
Obstetrics
End-stage renal disease after hypertensive disorders in pregnancy

https://doi.org/10.1016/j.ajog.2013.09.027Get rights and content

Objective

The purpose of this study was to determine the long-term postpartum risk of end-stage renal disease in women with hypertensive disorders in pregnancy. Although most women with hypertensive disorders in pregnancy recover after delivery, some may experience acute renal failure.

Study Design

We searched Taiwan's National Health Insurance Research Database to identify women with hypertensive disorders in pregnancies and deliveries between 1998 and 2002. All cases were followed for a maximum of 11 years (median, 9 years; interquartile range, 7.79–10.02 years) to estimate the incidence of end-stage renal disease; Cox regression analysis that was adjusted for potential confounding was used to determine the relative risk.

Results

Of the 13,633 women with hypertensive disorders in pregnancy, 46 experienced end-stage renal disease. Women with hypertensive disorders in pregnancy had a risk of end-stage renal disease that was 10.64 times greater than did women without them (95% confidence interval [CI], 7.53–15.05). The risk was highest in women with a history of preeclampsia superimposed on chronic hypertension (hazard ratio, 44.72; 95% CI, 22.59–88.51). Women with gestational hypertension had a higher risk of end-stage renal disease than did women without hypertensive disorders in pregnancy (hazard ratio, 5.82; 95% CI, 2.15–15.77).

Conclusion

Women with hypertensive disorders in pregnancy have a higher risk of postpartum end-stage renal disease, regardless of which type of hypertensive disorder they have. Women with a history of hypertensive disorders in pregnancy are encouraged to have regular postpartum checkups, especially of renal function.

Section snippets

Study population

The NHI program began in 1995 and covers 99% of Taiwan's population.20 All claims data are managed by the National Health Insurance Administration before being transferred to the National Health Research Institutes. We searched a subset of the NHI database for inpatient expenditures by admission codes to identify women who had deliveries between 1998 and 2002. The admission codes are determined by coders based on the physician-determined diagnoses that were recorded in patient charts. Patients

Results

The study population consisted of 944,474 women who, after giving birth, had been discharged from hospitals in Taiwan; of those women, 13,633 had a history of HDPs, and 930,841 did not. On average, the women with HDPs were older than those without and were more likely to have had a cesarean delivery, to have had only 1 delivery during the study period, and lived in an urban area (Table 1).

During the follow-up period, 0.34% and 0.02% of the women with and without HDPs, respectively, were

Comment

We found, in this population-based study, that HDPs were associated significantly with a higher risk of ESRD. The risk of ESRD was higher in women who gave birth at ≥35 years old. Women who previously had delivered a child after having an HDP had a lower risk of ESRD. Neither a cesarean section nor a delivery complication was a risk factor for ESRD after adjustment for age, delivery type, and number of deliveries after an HDP. Each type of HDP was associated with the risk of ESRD; women with

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    Supported by grant number CMFHR 9964 from Chi Mei Medical Center and grant number NHRI-NHIRD-99095 from the National Health Research Institute for the database.

    The authors report no conflict of interest.

    Reprints not available from the authors.

    Cite this article as: Wu C-C, Chen S-H, Ho C-H, et al. End-stage renal disease after hypertensive disorders in pregnancy. Am J Obstet Gynecol 2014;210:147.e1-8.

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