Rationale & Objective

Even though studies have demonstrated a relationship between hypertensive disorders of pregnancy (HDPs) and chronic kidney disease, there are limited data on the risk of acute kidney injury (AKI) following HDPs. We examined the risk of AKI following the occurrence of HDPs.

Study Design

Retrospective population-based cohort study.

Setting & Participants

Pregnant women in Ontario, Canada, aged 14-50 years, who delivered at ≥20 weeks’ gestation between April 1, 2002, and March 31, 2015.

Exposure

Preeclampsia, gestational hypertension, or neither.

Outcomes

The primary outcome was AKI with receipt of dialysis (AKI-D) ≥90 days after delivery. The main secondary outcome was AKI based on a hospitalization with a diagnostic code for AKI ≥90 days after delivery.

Analytical Approach

Time-dependent Cox proportional and cause-specific hazards models were used to evaluate the relationship between HDP and outcomes of interest. Models were adjusted for baseline and time-varying covariates.

Results

Our cohort comprised 1,142,656 women and 1,826,235 deliveries, of which 1.7% were associated with gestational hypertension and 4.4% with preeclampsia. After a mean follow-up of 6.7 years, there were 322 episodes of AKI-D (0.41 per 10,000 person-years) and 1,598 episodes of AKI based on diagnostic codes (2.04 per 10,000 person-years). After adjustment, neither preeclampsia nor gestational hypertension was associated with AKI-D. Preeclampsia was associated with AKI (HR, 1.22 [95% CI, 1.03-1.45]), but gestational hypertension was not.

Limitations

Retrospective design and possible unmeasured confounding. Cases of HDPs and AKI may have been undetected.

Conclusions

Preeclampsia was a risk factor for AKI occurring ≥90 days after delivery. Our findings suggest the potential importance of obtaining a pregnancy history as part of a comprehensive risk profile for acute kidney disease and suggest that women with a history of HDP may benefit from monitoring of kidney function.

中文翻译：

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妊娠期高血压疾病后急性肾损伤的风险：基于人群的队列研究

基本原理和目标

尽管研究表明妊娠期高血压疾病 (HDP) 与慢性肾病之间存在关系，但关于 HDP 后急性肾损伤 (AKI) 风险的数据有限。我们检查了 HDP 发生后 AKI 的风险。

学习规划

回顾性基于人群的队列研究。

设置与参与者

加拿大安大略省 14-50 岁的孕妇，在 2002 年 4 月 1 日至 2015 年 3 月 31 日期间在 ≥ 20 周妊娠时分娩。

接触

先兆子痫，妊娠高血压，或两者都不是。

结果

主要结局是分娩后≥90 天接受透析 (AKI-D) 的 AKI。主要的次要结局是基于住院且诊断代码为 AKI ≥ 90 天的分娩后的 AKI。

分析方法

时间依赖性 Cox 比例和特定原因危害模型用于评估 HDP 与感兴趣的结果之间的关系。模型针对基线和时变协变量进行了调整。

结果

我们的队列包括 1,142,656 名女性和 1,826,235 名分娩，其中 1.7% 与妊娠期高血压相关，4.4% 与先兆子痫相关。平均随访 6.7 年后，有 322 次 AKI-D 发作（0.41/10,000 人年）和 1,598 次基于诊断代码的 AKI 发作（2.04/10,000 人年）。调整后，先兆子痫和妊娠期高血压均与 AKI-D 无关。先兆子痫与 AKI 相关（HR，1.22 [95% CI，1.03-1.45]），但妊娠高血压与此无关。

限制

回顾性设计和可能的不可测量的混杂。HDP 和 AKI 病例可能未被发现。

结论

先兆子痫是分娩后≥90 天发生 AKI 的危险因素。我们的研究结果表明，将妊娠史作为急性肾病综合风险概况的一部分具有潜在重要性，并表明有 HDP 病史的女性可能受益于肾功能监测。