Li Dai1, Yue Chen2, Wen Sun3, Shiliang Liu4. 1. 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. 2. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON. 3. Research Institute for Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, China; Department of Obstetrics and Gynecology, Ottawa Hospital & University of Ottawa, Ottawa, ON. 4. 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. Electronic address: shiliang.liu@canada.ca.
Abstract
OBJECTIVE: To assess whether hypertensive disorders during pregnancy (HDPs) are associated with the subsequent development of end-stage renal disease (ESRD). METHODS: 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. RESULTS: 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. CONCLUSION: 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. Crown
OBJECTIVE: To assess whether hypertensive disorders during pregnancy (HDPs) are associated with the subsequent development of end-stage renal disease (ESRD). METHODS: 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. RESULTS: 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. CONCLUSION: 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. Crown
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