Kidney international reports · 2025
Impact of Preeclampsia on Long-Term Kidney Function in a Low-Resourced Setting.
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Davidson Bianca, Bramham Kate, Manning Kathryn, Osman Ayesha, Blumenthal Abigail, Clark Katherine, Beadmore-Gray Alice, Rayner Brian, Wearne Nicola, Jones Erika S W
Аннотация
INTRODUCTION: Hypertensive disorders of pregnancy (HDPs) affect approximately 10% of pregnancies, with disproportionate morbidity and mortality in low- and middle-income countries. Although long-term cardiovascular and kidney sequelae of preeclampsia are established in high-income settings, data from low- and middle-income countries remain scarce. We assessed incident hypertension, kidney dysfunction, and albuminuria following preeclampsia and associated risk factors.
METHODS: A prospective cohort study was conducted at Groote Schuur Hospital, South Africa, from January 2020 to October 2024. Clinical, demographic, and biochemical data were collected at delivery, first follow-up, and at 1- and 2-year visits. Logistic regression was used to assess predictors of hypertension, reduced estimated glomerular filtration rate (eGFR), and albuminuria, at time points stated above.
RESULTS: Of 241 women enrolled, 93 and 34 completed 1- and 2-year follow-up, respectively. The median age was 30 years (interquartile range [IQR]: 25-35), 50% had pregnancy-related acute kidney injury (AKI, Pr-AKI) and liver injury. Most (65%) delivered before 34 weeks. Incident hypertension persisted in 44% at first visit, 47% at 1 year, and 45% at 2 years. Reduced eGFR (< 90 ml/min per 1.73 m2) occurred in 22% at first visit and 20% at 1-year. Albuminuria persisted in > 50%. Pr-AKI predicted reduced eGFR (P = 0.013) and albuminuria (P = 0.015) at 1 year. HIV predicted reduced eGFR at first visit (P = 0.001), whereas elevated body mass index (BMI) predicted hypertension at 1 year (odds ratio [OR]: 3.98, P = 0.036).
CONCLUSION: Cardio-renal sequelae following preeclampsia were strikingly common, underscoring the need for integrated postpartum surveillance. In this cohort, Pr-AKI was an important determinant of chronic kidney disease (CKD).
METHODS: A prospective cohort study was conducted at Groote Schuur Hospital, South Africa, from January 2020 to October 2024. Clinical, demographic, and biochemical data were collected at delivery, first follow-up, and at 1- and 2-year visits. Logistic regression was used to assess predictors of hypertension, reduced estimated glomerular filtration rate (eGFR), and albuminuria, at time points stated above.
RESULTS: Of 241 women enrolled, 93 and 34 completed 1- and 2-year follow-up, respectively. The median age was 30 years (interquartile range [IQR]: 25-35), 50% had pregnancy-related acute kidney injury (AKI, Pr-AKI) and liver injury. Most (65%) delivered before 34 weeks. Incident hypertension persisted in 44% at first visit, 47% at 1 year, and 45% at 2 years. Reduced eGFR (< 90 ml/min per 1.73 m2) occurred in 22% at first visit and 20% at 1-year. Albuminuria persisted in > 50%. Pr-AKI predicted reduced eGFR (P = 0.013) and albuminuria (P = 0.015) at 1 year. HIV predicted reduced eGFR at first visit (P = 0.001), whereas elevated body mass index (BMI) predicted hypertension at 1 year (odds ratio [OR]: 3.98, P = 0.036).
CONCLUSION: Cardio-renal sequelae following preeclampsia were strikingly common, underscoring the need for integrated postpartum surveillance. In this cohort, Pr-AKI was an important determinant of chronic kidney disease (CKD).