End-stage renal disease after hypertensive disorders in pregnancy.
OBJECTIVE
The purpose of this study was to determine the long-term postpartum risk of end-stage renal disease in women with hypertensive disorders in pregnancy. Although most women with hypertensive disorders in pregnancy recover after delivery, some may experience acute renal failure.


METHODS
We searched Taiwan's National Health Insurance Research Database to identify women with hypertensive disorders in pregnancies and deliveries between 1998 and 2002. All cases were followed for a maximum of 11 years (median, 9 years; interquartile range, 7.79-10.02 years) to estimate the incidence of end-stage renal disease; Cox regression analysis that was adjusted for potential confounding was used to determine the relative risk.


RESULTS
Of the 13,633 women with hypertensive disorders in pregnancy, 46 experienced end-stage renal disease. Women with hypertensive disorders in pregnancy had a risk of end-stage renal disease that was 10.64 times greater than did women without them (95% confidence interval [CI], 7.53-15.05). The risk was highest in women with a history of preeclampsia superimposed on chronic hypertension (hazard ratio, 44.72; 95% CI, 22.59-88.51). Women with gestational hypertension had a higher risk of end-stage renal disease than did women without hypertensive disorders in pregnancy (hazard ratio, 5.82; 95% CI, 2.15-15.77).


CONCLUSIONS
Women with hypertensive disorders in pregnancy have a higher risk of postpartum end-stage renal disease, regardless of which type of hypertensive disorder they have. Women with a history of hypertensive disorders in pregnancy are encouraged to have regular postpartum checkups, especially of renal function.
Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Chia-Chun
CC
Wu
Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan; DA-AN Women and Children's Hospital, Tainan, Taiwan.
Sheng-Hsien
SH
Chen
Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Chung-Han
CH
Ho
Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Fu-Wen
FW
Liang
Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Chin-Chen
CC
Chu
Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan; Department of Sports Management, College of Leisure and Recreation Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Hsien-Yi
HY
Wang
Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan.
Yi-Hua
YH
Lu
D000328:Adult; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D016016:Proportional Hazards Models; D013624:Taiwan / Q000453:epidemiology
hypertensive disorder; renal disease