Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Pathology, University Medical Centre Groningen, Groningen, the Netherlands; Department of Medical Biology, University Medical Centre Groningen, Groningen, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands.
Am J Kidney Dis. 2018 May;71(5):619-626. doi: 10.1053/j.ajkd.2017.10.014. Epub 2017 Dec 28.
Registry-based studies report an increased risk for end-stage kidney disease after hypertensive disorders of pregnancy (HDPs). It is unclear whether HDPs lead to an increased incidence of chronic kidney disease (CKD) and/or progression of kidney function decline.
Subanalysis of the Prevention of Renal and Vascular Endstage Disease (PREVEND) Study, a Dutch population-based cohort with follow-up of 5 visits approximately 3 years apart.
SETTING & PARTICIPANTS: Women without and with patient-reported HDPs (non-HDP, n=1,805; HDP, n=977) were identified. Mean age was 50 years at baseline and median follow-up was 11 years.
An HDP.
(1) The incidence of CKD using Cox regression and (2) the course of kidney function (estimated glomerular filtration rate [eGFR] and 24-hour albuminuria) over 5 visits using generalized estimating equation analysis adjusted for age, mean arterial pressure, and renin-angiotensin system (RAS) blockade. CKD was defined as eGFR<60mL/min/1.73m and/or 24-hour albuminuria with albumin excretion > 30mg, and end-stage kidney disease was defined as receiving dialysis or kidney transplantation.
During follow-up, none of the women developed end-stage renal disease and the incidence of CKD during follow-up was similar across HDP groups (HR, 1.04; 95% CI, 0.79-1.37; P=0.8). Use of RAS blockade was higher after HDP at all visits. During a median of 11 years, we observed a decrease in eGFR in both groups, with a slightly steeper decline in the HDP group (98±15 to 88±16 vs 99±17 to 91±15mL/min/1.73m; P<0.01, P<0.05). The group effect remained significant after adjusting for mean arterial pressure, but disappeared after adjusting for RAS blockade. The 24-hour albuminuria did not differ between groups.
No obstetric records available. HDPs defined by patient report rather than health records.
HDPs did not detectably increase the incidence of CKD. During follow-up, we observed no differences in albuminuria, but observed a marginally lower eGFR after HDP that was no longer statistically significant after adjusting for the use of RAS blockers. In this population, we were unable to identify a significant risk for kidney function decline after patient-reported HDP.
基于登记的研究报告称，妊娠高血压疾病（HDP）后发生终末期肾病的风险增加。目前尚不清楚 HDP 是否会导致慢性肾脏病（CKD）发病率增加和/或肾功能下降的进展。
荷兰人群为基础的 PREVEND 研究的亚组分析，随访 5 次，每次约 3 年。
确定无患者报告的 HDP（非 HDP，n=1805；HDP，n=977）和有 HDP 的女性。基线时的平均年龄为 50 岁，中位随访时间为 11 年。
HDP。
（1）使用 Cox 回归分析 CKD 的发生率；（2）使用广义估计方程分析调整年龄、平均动脉压和肾素-血管紧张素系统（RAS）阻滞剂后 5 次就诊期间肾功能的变化（估计肾小球滤过率[eGFR]和 24 小时白蛋白尿）。CKD 的定义为 eGFR<60mL/min/1.73m 和/或 24 小时白蛋白尿排泄>30mg，终末期肾病定义为接受透析或肾移植。
在随访期间，没有女性发展为终末期肾病，随访期间 HDP 组之间的 CKD 发生率相似（HR，1.04；95%CI，0.79-1.37；P=0.8）。在所有就诊时，HDP 后 RAS 阻滞剂的使用更高。在中位 11 年期间，我们观察到两组的 eGFR 均下降，HDP 组下降更明显（98±15 至 88±16 与 99±17 至 91±15mL/min/1.73m；P<0.01，P<0.05）。调整平均动脉压后，组间差异仍有统计学意义，但调整 RAS 阻滞剂后差异消失。两组的 24 小时白蛋白尿无差异。
没有可用的产科记录。HDP 由患者报告而非健康记录定义。
HDP 未明显增加 CKD 的发病率。在随访期间，我们观察到白蛋白尿无差异，但在 HDP 后观察到 eGFR 略有下降，在调整 RAS 阻滞剂的使用后，这一差异不再具有统计学意义。在该人群中，我们无法确定 HDP 后肾功能下降的显著风险。
