Assessing the risk of preeclampsia/eclampsia in Mississippi black women with chronic kidney disease using electronic health records

Objectives: Preeclampsia (PE) is risk factor for renal dysfunction, and chronic kidney disease (CKD) is associated with higher prevalence of PE. However, the role of preexisting CKD in PE development in minority mothers has been understudied. Additionally, previous studies rarely examine CKD on PE risk independent from common comorbidities seen in patients with CKD such as hypertension (HTN) and diabetes. Our objective was to determine whether there were disparities in PE risk and overall outcomes in mothers with and without preexisting CKD in white and black mothers from a single-center in Mississippi. Study design: We retrospectively analyzed electronic health records (EHR) from de-identified mothers with known gestation dates (n = 29,451) from the University of Mississippi Medical Center from 2013 to 2022. Results: Black mothers had a significantly increased prevalence of CKD (0.9%) as compared to white mothers (0.6%), which was associated with a higher prevalence of PE (38%) as compared to white CKD mothers (23%). Baseline CKD was also associated with a significantly increased risk of all-cause mortality in blacks but not whites. After controlling for age, medication, baseline HTN, and diabetes, black race (HR 1.7) and CKD (HR 3.2) were major independent risk factors for PE. Conclusion: Although the underlying mechanisms remain unclear, these findings are crucial for improving preand post-parturition care for Black CKD pregnant patients to benefit both the fetus and mother. In a rural Mississippi population, our data demonstrates a significant association of pre-existing CKD and incident PE in black patients, suggesting a potential role for renal dysfunction in driving the increased prevalence of PE in this population. Future research aims to investigate genetic factors causing renal and endothelial changes to better understand and address the causes of higher rates of preeclampsia in black women with CKD.