From the Division of Nephrology, Department of Medicine (J.S.T., E.A., R.T.)
Harvard Medical School Boston, MA (J.S.T., C.E.P., J.E., S.A.K., R.T.).
Hypertension. 2018 Aug;72(2):451-459. doi: 10.1161/HYPERTENSIONAHA.118.11161. Epub 2018 Jun 18.
An episode of clinically recovered acute kidney injury (r-AKI) has been identified as a risk factor for future hypertension and cardiovascular disease. Our objective was to assess whether r-AKI was associated with future preeclampsia and other adverse pregnancy outcomes and to identify whether severity of AKI or time interval between AKI and pregnancy was associated with pregnancy complications. We conducted a retrospective cohort study of women who delivered infants between 1998 and 2016 at Massachusetts General Hospital. AKI was defined using the 2012 Kidney Disease Improving Global Outcomes laboratory criteria with subsequent clinical recovery (estimate glomerular filtration rate, >90 mL/min per 1.73 m before conception). AKI was further classified by severity (Kidney Disease Improving Global Outcomes stages 1-3) and time interval between AKI episode and the start of pregnancy. Women with r-AKI had an increased rate of preeclampsia compared with women without previous r-AKI (22% versus 9%; <0.001). Infants of women with r-AKI were born earlier (gestational age, 38.2±3.0 versus 39.0±2.2 weeks; <0.001) and were more likely to be small for gestational age (9% versus 5%; =0.002). Increasing severity of r-AKI was associated with increased risk of preeclampsia for stages 2 and 3 AKI (adjusted odds ratio, 3.5; 95% confidence interval, 2.1-5.7 and adjusted odds ratio, 6.5; 95% confidence interval, 3.5-12.0, respectively), but not for stage 1 (adjusted odds ratio, 1.7; 95% confidence interval, 0.9-3.2). A history of AKI before pregnancy, despite apparent full recovery, was associated with increased risk of pregnancy complications. Severity and timing of the AKI episode modified the risk.
临床上已康复的急性肾损伤 (r-AKI) 发作被确定为未来高血压和心血管疾病的危险因素。我们的目的是评估 r-AKI 是否与未来的子痫前期和其他不良妊娠结局相关，并确定 AKI 的严重程度或 AKI 与妊娠之间的时间间隔是否与妊娠并发症相关。我们对 1998 年至 2016 年在马萨诸塞州总医院分娩的女性进行了回顾性队列研究。使用 2012 年肾脏病改善全球结局实验室标准定义 AKI，并随后出现临床恢复（估算肾小球滤过率，在受孕前 >90 mL/min/1.73 m ）。根据严重程度（肾脏病改善全球结局阶段 1-3）和 AKI 发作与妊娠开始之间的时间间隔进一步对 AKI 进行分类。与没有既往 r-AKI 的女性相比，r-AKI 女性的子痫前期发生率更高（22%比 9%；<0.001）。r-AKI 女性的婴儿出生更早（胎龄，38.2±3.0 比 39.0±2.2 周；<0.001），更有可能为小于胎龄儿（9%比 5%；=0.002）。r-AKI 严重程度的增加与 2 期和 3 期 AKI 的子痫前期风险增加相关（调整后的优势比，3.5；95%置信区间，2.1-5.7 和调整后的优势比，6.5；95%置信区间，3.5-12.0），但 1 期 AKI 则不然（调整后的优势比，1.7；95%置信区间，0.9-3.2）。尽管 AKI 明显完全恢复，但妊娠前的 AKI 病史与妊娠并发症风险增加相关。AKI 发作的严重程度和时间改变了风险。
