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Association Between Hypertensive Disorders During Pregnancy and the Subsequent Risk of End-Stage Renal Disease: A Population-Based Follow-Up Study

  • Li Dai
    Affiliations
    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
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  • Yue Chen
    Affiliations
    School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON
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  • Wen Sun
    Affiliations
    Research Institute for Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, China

    Department of Obstetrics and Gynecology, Ottawa Hospital & University of Ottawa, Ottawa, ON
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  • Shiliang Liu
    Correspondence
    Corresponding Author: Dr. Shiliang Liu, Maternal, Child and Youth Health Division Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON.
    Affiliations
    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
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      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)
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