Kattah Andrea G, Scantlebury Dawn C, Agarwal Sanket, Mielke Michelle M, Rocca Walter A, Weaver Amy L, Vaughan Lisa E, Miller Virginia M, Weissgerber Tracey L, White Wendy, Garovic Vesna D
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Services, The Queen Elizabeth Hospital, Barbados.
Am J Kidney Dis. 2017 Apr;69(4):498-505. doi: 10.1053/j.ajkd.2016.07.034. Epub 2016 Oct 1.
Several registry-based studies, using diagnostic codes, have suggested that preeclampsia is a risk factor for end-stage renal disease (ESRD). However, because the 2 diseases share risk factors, the true nature of their association remains uncertain. Our goals were to conduct a population-based study to determine the magnitude of the association between preeclampsia and ESRD and evaluate the role of shared risk factors.
Population-based nested case-control study.
SETTING & PARTICIPANTS: The US Renal Data System was used to identify women with ESRD from a cohort of 34,581 women who gave birth in 1976 to 2010 in Olmsted County, MN. 44 cases of ESRD were identified and each one was matched to 2 controls based on year of birth (±1 year), age at first pregnancy (±2 years), and parity (±1 or ≥4).
Preeclamptic pregnancy, confirmed by medical record review.
ESRD.
Prepregnancy serum creatinine and urine protein measurements were recorded. Comorbid conditions existing prior to pregnancy were abstracted from medical records and included kidney disease, obesity, diabetes, and hypertension.
There was evidence of kidney disease prior to the first pregnancy in 9 of 44 (21%) cases and 1 of 88 (<1%) controls. Per chart review, 8 of 44 (18%) cases versus 4 of 88 (5%) controls had preeclamptic pregnancies (unadjusted OR, 4.0; 95% CI, 1.21-13.28). Results were similar after independent adjustment for race, education, diabetes, and hypertension prior to pregnancy. However, the association was attenuated and no longer significant after adjustment for obesity (OR, 3.25; 95% CI, 0.93-11.37).
The limited number of ESRD cases and missing data for prepregnancy kidney function.
Our findings confirm that there is a sizable association between preeclampsia and ESRD; however, obesity is a previously unexplored confounder. Pre-existing kidney disease was common, but not consistently coded or diagnosed.
多项基于登记处的研究使用诊断编码表明，子痫前期是终末期肾病（ESRD）的一个危险因素。然而，由于这两种疾病有共同的危险因素，它们之间关联的真实性质仍不确定。我们的目标是开展一项基于人群的研究，以确定子痫前期与ESRD之间关联的程度，并评估共同危险因素的作用。
基于人群的巢式病例对照研究。
利用美国肾脏数据系统从明尼苏达州奥尔姆斯特德县1976年至2010年分娩的34581名女性队列中识别出患有ESRD的女性。确定了44例ESRD病例，每例根据出生年份（±1年）、首次怀孕年龄（±2年）和平产次数（±1次或≥4次）与2名对照进行匹配。
经病历审查确诊的子痫前期妊娠。
ESRD。
记录孕前血清肌酐和尿蛋白测量值。从病历中提取妊娠前存在的合并症，包括肾病、肥胖、糖尿病和高血压。
44例病例中有9例（21%）和88例对照中有1例（<1%）在首次怀孕前有肾病证据。经病历审查，44例病例中有8例（18%）与88例对照中有4例（5%）有子痫前期妊娠（未调整的比值比，4.0；95%可信区间，1.21 - 13.28）。在对种族、教育程度、糖尿病和妊娠前高血压进行独立调整后，结果相似。然而，在对肥胖进行调整后，这种关联减弱且不再显著（比值比，3.25；95%可信区间，0.93 - 11.37）。
ESRD病例数量有限以及孕前肾功能数据缺失。
我们的研究结果证实子痫前期与ESRD之间存在相当大的关联；然而，肥胖是一个此前未被探索的混杂因素。孕前存在的肾病很常见，但编码或诊断并不一致。
