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.
Résumé
Objectifs
Déterminer si les troubles hypertensifs de la grossesse (THG) sont associés au développement
subséquent d'une insuffisance rénale terminale (IRT).
Méthodologie
Nous nous sommes penchés sur 1 598 043 patientes ayant accouché dans des hôpitaux
canadiens entre avril 1993 et mars 2003. Nous avons interrogé la Base de données sur
les congés des patients de l'Institut canadien d'information sur la santé pour recueillir
les données de références. Les femmes atteintes de troubles rénaux chroniques, de
diabète et d'autres troubles particuliers ont été exclues. Une étude de suivi a été
menée par couplage des données relatives aux hospitalisations survenues entre le 13e mois après l'obtention du congé post-accouchement et le 31 mars 2013. La principale
issue d'intérêt était une hospitalisation subséquente en raison d'une IRT. L'association
entre les THG et ces hospitalisations a été quantifiée à l'aide du modèle de Cox.
Résultats
Le suivi a révélé qu'il y avait eu respectivement 9,9 et 1,7 hospitalisations pour
IRT par 100 000 personnes-années chez les femmes atteintes et non atteintes de THG.
Un risque accru d'hospitalisation pour IRT a été constaté chez les femmes enceintes
atteintes de prééclampsie ou d'éclampsie (rapport de risque ajusté [RRA] = 4,7; IC
à 95 % : 3,6 à 6,0), de THG non précisés (RRA = 4,6; IC à 95 % : 2,8 à 7,7), ou d'hypertension
gravidique (RRA = 3,3; IC à 95 % : 2,1 à 5,1). Il a été déterminé qu'une corrélation
significative liait la césarienne, l'accouchement prématuré, le RCIU et la thrombose
veineuse profonde à l'hospitalisation subséquente pour IRT. Le risque semblait moindre
chez les femmes ayant accouché deux fois ou plus pendant la période à l'étude que
chez celles ayant accouché une seule fois.
Conclusion
Les THG ont été fortement associés au risque accru d'hospitalisation ultérieure en
raison d'une IRT; l'importance de cette association variait selon le type de THG et
le nombre d'accouchements.
Key Words
Abbreviations:
aHR (adjusted hazard ratio), CIHI (Canadian Institute for Health Information), DAD (Discharge Abstract Database), ESRD (end-stage renal disease), HCN (health care number), HDP (hypertensive disorder during pregnancy), IUGR (intrauterine growth restriction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 19, 2018
Accepted:
January 13,
2018
Received:
October 10,
2017
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
