Preeclampsia and ESRD: The Role of Shared Risk Factors

Andrea G. Kattah, Dawn C. Scantlebury, Sanket Agarwal, Michelle M Mielke, Walter A Rocca, Amy L. Weaver, Lisa E. Vaughan, Virginia M Miller, Tracey L. Weissgerber, Wendy White, Vesna D Garovic

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Background: Several registry-based studies, using diagnostic codes, have suggested that preeclampsia is a risk factor for end-stage renal disease (ESRD). However, because the 2 diseases share risk factors, the true nature of their association remains uncertain. Our goals were to conduct a population-based study to determine the magnitude of the association between preeclampsia and ESRD and evaluate the role of shared risk factors. Study Design: Population-based nested case-control study. Setting & Participants: The US Renal Data System was used to identify women with ESRD from a cohort of 34,581 women who gave birth in 1976 to 2010 in Olmsted County, MN. 44 cases of ESRD were identified and each one was matched to 2 controls based on year of birth (±1 year), age at first pregnancy (±2 years), and parity (±1 or ≥4). Predictor: Preeclamptic pregnancy, confirmed by medical record review. Outcome: ESRD. Measurements: Prepregnancy serum creatinine and urine protein measurements were recorded. Comorbid conditions existing prior to pregnancy were abstracted from medical records and included kidney disease, obesity, diabetes, and hypertension. Results: There was evidence of kidney disease prior to the first pregnancy in 9 of 44 (21%) cases and 1 of 88 (<1%) controls. Per chart review, 8 of 44 (18%) cases versus 4 of 88 (5%) controls had preeclamptic pregnancies (unadjusted OR, 4.0; 95% CI, 1.21-13.28). Results were similar after independent adjustment for race, education, diabetes, and hypertension prior to pregnancy. However, the association was attenuated and no longer significant after adjustment for obesity (OR, 3.25; 95% CI, 0.93-11.37). Limitations: The limited number of ESRD cases and missing data for prepregnancy kidney function. Conclusions: Our findings confirm that there is a sizable association between preeclampsia and ESRD; however, obesity is a previously unexplored confounder. Pre-existing kidney disease was common, but not consistently coded or diagnosed.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Apr 5 2016

Keywords

  • End-stage renal disease (ESRD)
  • Hypertension
  • Hypertensive pregnancy disorders
  • Obesity
  • Preeclampsia
  • Pregnancy
  • Risk factor
  • Toxemia

ASJC Scopus subject areas

  • Nephrology

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    Kattah, A. G., Scantlebury, D. C., Agarwal, S., Mielke, M. M., Rocca, W. A., Weaver, A. L., Vaughan, L. E., Miller, V. M., Weissgerber, T. L., White, W., & Garovic, V. D. (Accepted/In press). Preeclampsia and ESRD: The Role of Shared Risk Factors. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2016.07.034