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Hypertensive Diseases in Pregnancy and Kidney Function Later in Life

The Genetic Epidemiology Network of Arteriopathy (GENOA) Study
Published:September 24, 2021DOI:https://doi.org/10.1016/j.mayocp.2021.07.018

      Abstract

      Objective

      To evaluate the relationship between hypertensive diseases in pregnancy and kidney function later in life.

      Methods

      We evaluated measured glomerular filtration rate (mGFR) using iothalamate urinary clearance in 725 women of the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Women were classified by self-report as nulliparous (n=62), a history of normotensive pregnancies (n=544), a history of hypertensive pregnancies (n=102), or a history of pre-eclampsia (n=17). We compared adjusted associations among these four groups with mGFR using generalized estimating equations to account for familial clustering. Chronic kidney disease (CKD) was defined as mGFR of less than 60 mL/min per 1.73 m2 or urinary albumin-creatinine ratio (UACR) greater than or equal to 30 mg/g.

      Results

      Among women with kidney function measurements (mean age, 59±9 years, 52.9% African American), those with a history of hypertensive pregnancy had lower mGFR (–4.66 ml/min per 1.73 m2; 95% CI, -9.12 to -0.20) compared with women with a history of normotensive pregnancies. Compared with women with a history of normotensive pregnancies, women with a history of hypertensive pregnancy also had higher odds of mGFR less than 60 ml/min per 1.73 m2 (odds ratio, 2.09; 95% CI, 1.21 to 3.60). Additionally, women with a history of hypertensive pregnancy had greater odds for chronic kidney disease (odds ratio, 4.89; 95% CI, 1.55 to 15.44), after adjusting for age, race, education, smoking history, hypertension, body mass index, and diabetes.

      Conclusion

      A history of hypertension in pregnancy is an important prognostic risk factor for kidney disease. To our knowledge, this is the first and largest investigation showing the association between hypertensive diseases in pregnancy and subsequent kidney disease using mGFR in a large biracial cohort.

      Abbreviations and Acronyms:

      AHA (American Heart Association), BMI (body mass index), CKD (chronic kidney disease), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), GFR (glomerular filtration rate), HDP (hypertensive diseases in pregnancy), HR (hazard ratio), HX (history), HTN (hypertensive pregnancy), mGFR (GFR measured with iothalamate urinary clearance), NP (nulliparous), NTN (normotensive pregnancy), PE (pre-eclamptic pregnancy), UACR (urinary albumin-creatinine ratio)
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