The dilemma of chronic kidney disease and end-stage kidney disease following pre-eclampsia: a literature review and meta-analysis.

PURPOSE

Pre-eclampsia (PE) is a pregnancy-related multisystem syndrome, characterized by the sudden onset of hypertension after 20 weeks' gestation. Although previous studies and meta-analyses found an association between pre-eclampsia and chronic kidney disease or end-stage kidney disease later in life, it remains unclear whether this relationship is causal. Furthermore, research conducted to date has not consistently excluded women with chronic hypertension and/or kidney disease prior to pregnancy, indicating a possible selection bias. Therefore, we undertook a systematic review of the updated literature on renal outcomes in women who were healthy prior to pregnancy and experienced pre-eclampsia.

METHODS

We searched PubMed-MEDLINE and Embase for eligible studies. We included retrospective and prospective studies involving healthy women with pre-eclampsia and reporting kidney outcomes. Of the 2,796 titles originally screened, 9 studies met our inclusion criteria. A random effects meta-analytic model was used for statistical analysis.

RESULTS

A statistically significant increase in the risk of developing chronic kidney disease and end-stage kidney disease later in life following pre-eclampsia was found (meta-analytic risk ratios [95% confidence interval]: 1.83 [1.16-2.89] and 8.96 [4.94-16.23], respectively), with high statistical heterogeneity. However, the only prospective study did not find a significant association between pre-eclampsia and chronic kidney disease.

CONCLUSIONS

Although a significant association was identified, its clinical relevance and causality remain unclear. Postpartum medical investigation in women affected by pre-eclampsia is essential, but long-term follow-up may not be indicated in the absence of underlying conditions. Only prospective studies could clarify the relationship between pre-eclampsia and kidney disease in women who were healthy before pregnancy.