The risk of persistent hypertension and chronic kidney disease in early and late-onset preeclampsia, a report from a low middle income country

Abstract

Abstract Background Early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP) are associated with different maternal and fetal outcomes, biochemical markers, and clinical characteristics. Nevertheless, only a few data were presented about its long-term effects on kidney function later in life. Objective This study aimed to explore the risk of persistent hypertension and kidney failure in EOP and LOP in five years after delivery. Study Design: This retrospective cohort study included women with prior history of severe preeclampsia or normotensive pregnancy admitted to one of tertiary hospitals in Indonesia. The blood pressure, body mass index, urea and creatinine serum, and protein urine were analyzed, and risk of chronic kidney disease (CKD) was performed using KDIGO classification. Results A total of 27 EOP, 35 LOP and 30 normotensive cases were included. Mean blood pressure after five years recorded respectively 115.6 ± 14.25 mmHg in normotensive group, 131.82 ± 19.34 mmHg in LOP group, and 154.96 ± 23.48 mmHg in EOP group. Percentage of women with positive protein urine varied from 13.3–31.4% and 66.7% in normotensive, LOP, and EOP, respectively. According to KDIGO classification, normotensive group had 90% of low-risk CKD, whereas the severe preeclampsia group had 41.9% of high-risk CKD. In the severe preeclampsia group, the risk of CKD was 20.94 times higher compared to normotensive women (OR 20.94; 95% CI [2.67-163.72], p = 0.004). Then risk of CKD in EOP group was 6.75 times higher than LOP group (OR 6.75; 95% CI [2.19–20.76], p = 0.001), whereas persistent hypertension in EOP group was 5.78 times higher than LOP group (OR 5.78; 95% CI [1.91-17.395], p = 0.002). Conclusions Preeclampsia women have a higher risk of CKD than normotensive women. Women with a history of EOP are more likely to develop persistent hypertension and CKD than women with prior LOP history.