Dai Li, Chen Yue, Sun Wen, Liu Shiliang
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON; Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON.
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON.
J Obstet Gynaecol Can. 2018 Sep;40(9):1129-1138. doi: 10.1016/j.jogc.2018.01.022. Epub 2018 Jun 19.
To assess whether hypertensive disorders during pregnancy (HDPs) are associated with the subsequent development of end-stage renal disease (ESRD).
The present study included 1 598 043 women who delivered in Canadian hospitals between April 1993 and March 2003. The baseline information was from the Canadian Institute for Health Information's Discharge Abstract Database. Women with chronic kidney disease, diabetes mellitus, and other specific conditions were excluded. A follow-up study was conducted through a record linkage on their hospitalizations as of the 13th month after the delivery discharge through March 31, 2013. The primary outcome of interest was subsequent hospitalization due to ESRD. Cox model was used to quantify the association between HDPs and ESRD hospitalization.
There occurred 9.9 and 1.7 ESRD hospitalizations per 100 000 person-years in the follow-up of HDPs and non-HDP women, respectively. An increased risk of ESRD hospitalization was observed in pregnant women with pre-eclampsia/eclampsia (adjusted hazard ratio [aHR] = 4.7, 95% CI 3.6-6.0), unspecified HDPs (aHR = 4.6, 95% CI 2.8-7.7), or gestational hypertension (aHR = 3.3, 95% CI 2.1-5.1). Caesarean delivery, preterm delivery, IUGR, and deep vein thrombosis were identified as significant correlates with the subsequent ESRD hospitalization. The risk of subsequent ESRD hospitalization appeared to be lower for women who had ≥2 deliveries compared with those who had one delivery during the study period.
Pregnancy complicated with HDPs was significantly associated with an increased risk of ESRD hospitalization in later life, and this association varied by HDP subtype and frequency of delivery.
评估妊娠期高血压疾病（HDPs）是否与终末期肾病（ESRD）的后续发生有关。
本研究纳入了1993年4月至2003年3月在加拿大医院分娩的1598043名女性。基线信息来自加拿大卫生信息研究所的出院摘要数据库。排除患有慢性肾病、糖尿病和其他特定疾病的女性。通过对她们出院后第13个月至2013年3月31日期间的住院记录进行关联分析进行随访研究。主要关注的结局是因ESRD导致的后续住院。采用Cox模型量化HDPs与ESRD住院之间的关联。
在HDPs组和非HDPs组女性的随访中，ESRD住院发生率分别为每10万人年9.9例和1.7例。子痫前期/子痫孕妇（校正风险比[aHR]=4.7，95%可信区间[CI]3.6 - 6.0）、未明确的HDPs孕妇（aHR = 4.6，95% CI 2.8 - 7.7）或妊娠期高血压孕妇（aHR = 3.3，95% CI 2.1 - 5.1）发生ESRD住院的风险增加。剖宫产、早产、胎儿生长受限和深静脉血栓形成被确定为与后续ESRD住院的显著相关因素。与研究期间分娩1次的女性相比，分娩≥2次的女性后续发生ESRD住院的风险似乎更低。
妊娠合并HDPs与晚年发生ESRD住院的风险显著增加相关，且这种关联因HDPs亚型和分娩次数而异。
