Preeclampsia a Marker for Increased Risk of End-Stage Renal Disease

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Title: Preeclampsia a Marker for Increased Risk of End-Stage Renal Disease
URL: http://www.pslgroup.com/dg/229A4A.htm
Doctor's Guide
August 22, 2008

NEW YORK -- August 22, 2008 -- Preeclampsia is a clinical marker for an increased risk of subsequent end-stage renal disease (ESRD), although the absolute risk is low, according to a study published in the August 21 issue of the New England Journal of Medicine.

"Based on the fact that women with a history of preeclampsia have increased risk of renal and cardiovascular disease, we believe that these women should be advised of a healthy lifestyle with weight reduction, smoking cessation, and regular follow-up by their physician with measurements of blood pressure, microalbuminuria, and other cardiovascular risk factors," Dr. Vikse told DocGuide.

Several investigations have suggested that preeclampsia may be associated with several risk factors after pregnancy including cardiovascular and renal disease.

In addition, "studies have shown increased rates of microalbuminuria up to 5 years after pregnancy in women with previous preeclampsia, a finding that is compatible with the presence of underlying unrecognised renal disease," said the authors.

Bjørn Egil Vikse, MD, PhD, University of Bergen and Haukeland University Hospital, Bergen, Norway, and colleagues set out to determine whether preeclampsia is associated with ESRD and whether a history of preeclampsia in more than 1 pregnancy increases this risk.

The authors linked data from 2 large registries -- the Medical Birth Registry of Norway, which contains data on all births in Norway since 1967, and the Norwegian Renal Registry, which contains dataon all patients receiving a diagnosis of ESRD since 1980.

The study population consisted of women who had had a first, single birth between 1967 and 1991. Data from up to 3 pregnancies was included.

Of the 570,433 women included in the study, ESRD developed in 477 women (overall rate, 3.7 per 100,000 women per year). ESRD was diagnosed a mean 17.9 years after the first pregnancy.

Among women who had been pregnant 1 or more times, preeclampsia during the first pregnancy was associated with a relative risk of ESRD of 4.7 (95% confidence interval [CI], 3.6-6.1).

Women who had been pregnant 2 or more times and had preeclampsia during the first pregnancy were also associated with a relative risk of ESRD of 3.2 (95% CI, 2.2-4.9). Preeclampsia during the second pregnancy had a relative risk of 6.7 (95% CI, 4.3-10.6), and preeclampsia during both pregnancies had a relative risk of 6.4 (95% CI, 3.0-13.5).

In women who had been pregnant 3 or more times, preeclampsia during 1 pregnancy was associated with a relative risk of ESRD of 6.3 (95% CI, 4.1-9.9), and preeclampsia during 2 or 3 pregnancies was associated with a relative risk of 15.5 (95% CI, 7.8-30.8).

In addition, having a low-birth-weight or preterm infant increased the relative risk of ESRD. The results were similar after adjustment for possible confounders and after exclusion of women who had kidney disease, rheumatic disease, essential hypertension, or diabetes before pregnancy.

"It would probably be sufficient to do this follow-up every 2 or 3 years but no studies have investigated the cost-benefit of this. As ESRD is more common in the United States than in Norway, the cost-benefit may be a lot higher in the United States than in Norway, arguing for closer follow-up," Dr. Vikse told DocGuide.

"All women with preeclampsia should be investigated after their pregnancy to see if their proteinuria disappears, as women who have underlying renal disease will most often have persistent proteinuria also after pregnancy."

The authors stated that limitations to the study included lack of data on subjects before 1980, possible undetected or unreported renal disease during pregnancy in some women, and lack of data from these women on smoking obesity factors.

"We are planning some studies that in part may take into account other factors like smoking and obesity but have not yet prepared the final design of these studies," Dr. Vikse told DocGuide.

SOURCE: New England Journal of Medicine

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