n e w e ng l a n d j o u r na l
m e dic i n e
Preeclampsia and the Risk of End-Stage Renal Disease
Bjørn Egil Vikse, M.D., Ph.D., Lorentz M. Irgens, M.D., Ph.D., Torbjørn Leivestad, M.D., Ph.D., Rolv Skjærven, Ph.D., and Bjarne M. Iversen, M.D., Ph.D.
A BS T R AC T
From the Renal Research Group, Institute of Medicine (B.E.V., B.M.I.), theSection for Epidemiology and Medical Statistics (L.M.I., R.S.), and the Locus for RegistryBased Epidemiology (B.E.V., L.M.I., R.S., B.M.I.), University of Bergen; the Department of Medicine, Haukeland University Hospital (B.E.V., B.M.I.); and the Medical Birth Registry of Norway, Norwegian Institute of Public Health (L.M.I., R.S.) — all in Bergen, Norway; and the Norwegian Renal Registry, Instituteof Immunology, Rikshospitalet, Oslo (T.L.). Address reprint requests to Dr. Vikse at the Renal Research Group, Institute of Medicine, Haukeland University Hospital, Bergen 5021, Norway, or at firstname.lastname@example.org. N Engl J Med 2008;359:800-9.
Copyright © 2008 Massachusetts Medical Society.
It is unknown whether preeclampsia is a risk marker for subsequent end-stage renal disease (ESRD).Methods
We linked data from the Medical Birth Registry of Norway, which contains data on all births in Norway since 1967, with data from the Norwegian Renal Registry, which contains data on all patients receiving a diagnosis of end-stage renal disease (ESRD) since 1980, to assess the association between preeclampsia in one or more pregnancies and the subsequent development of ESRD. The studypopulation consisted of women who had had a first singleton birth between 1967 and 1991; we included data from up to three pregnancies.
ESRD developed in 477 of 570,433 women a mean (±SD) of 17±9 years after the first pregnancy (overall rate, 3.7 per 100,000 women per year). Among women who had been pregnant one or more times, preeclampsia during the first pregnancy was associated with arelative risk of ESRD of 4.7 (95% confidence interval [CI], 3.6 to 6.1). Among women who had been pregnant two or more times, preeclampsia during the first pregnancy was associated with a relative risk of ESRD of 3.2 (95% CI, 2.2 to 4.9), preeclampsia during the second pregnancy with a relative risk of 6.7 (95% CI, 4.3 to 10.6), and preeclampsia during both pregnancies with a relative risk of 6.4(95% CI, 3.0 to 13.5). Among women who had been pregnant three or more times, preeclampsia during one pregnancy was associated with a relative risk of ESRD of 6.3 (95% CI, 4.1 to 9.9), and preeclampsia during two or three pregnancies was associated with a relative risk of 15.5 (95% CI, 7.8 to 30.8). Having a low-birth-weight or preterm infant increased the relative risk of ESRD. The results weresimilar after adjustment for possible confounders and after exclusion of women who had kidney disease, rheumatic disease, essential hypertension, or diabetes mellitus before pregnancy.
Although the absolute risk of ESRD in women who have had preeclampsia is low, preeclampsia is a marker for an increased risk of subsequent ESRD.
n engl j med 359;8
Downloaded from www.nejm.org on November 2, 2009 . Copyright © 2008 Massachusetts Medical Society. All rights reserved.
Preeclampsia and End-Stage Renal Disease
everal investigations have suggested that preeclampsia may be associated with the development of cardiovascular disease,1-4 renal disease,5 and cardiovascular risk factors6-11 for several years after pregnancy. Otherstudies have shown increased rates of microalbuminuria up to 5 years after pregnancy in women with previous preeclampsia,12,13 a finding that is compatible with the presence of underlying unrecognized renal disease or a damaging effect of preeclampsia on the kidney. It is uncertain whether these associations are explained by adverse effects of preeclampsia itself or by underlying risk factors that...
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