Preeclampsia and Long-term Kidney Outcomes: An Observational Cohort Study

Rationale & Objective: Preeclampsia is a pregnancy-related complication characterized by acute hypertension and end-organ dysfunction. We evaluated the long-term association between preeclampsia and the risk of developing chronic hypertension and kidney disease. Study Design: Observational cohort study. Setting & Participants: 27,800 adults with de-liveries in the Geisinger Health System between 1996 and 2019. Exposure: Preeclampsia. Outcome: Hypertension, reduced estimated glomerular filtration rate (eGFR) < 60 mL/min/ 1.73 m2), and albuminuria > 300 mg/g. Analytical Approach: Propensity-score matching and Cox proportional hazards models to evaluate the association between preeclampsia and incident hypertension, reduced eGFR, and albuminuria. Results: Of 27,800 adults with pregnancies during the study period (mean age, 28 years; 3% Black race), 2,977 (10.7%) had at least 1 preg-nancy complicated by preeclampsia. After matching for multiple characteristics, individuals with preeclampsia had a higher risk of developing chronic hypertension (HR, 1.77 [95% CI, 1.45-2.16]), eGFR < 60 mL/min/1.73 m2 (HR, 3.23 [95% CI, 1.64-6.3 6]), albuminuria (HR, 3.60 [95% CI, 2.38-5.44]), and a subsequent episode of preeclampsia (HR, 24.76 [95% CI, 12.47-48.3 6]), compared with matched controls without preeclampsia. Overall, postpartum follow-up testing was low. In the first 6 months after delivery, 31% versus 14% of individuals with and without preeclampsia had serum creatinine tests, respectively, and testing for urine protein was the same in both groups, with only 26% having follow-up testing. Limitations: Primarily White study population, observational study, reliance on ICD codes for medical diagnosis. Conclusions: Individuals with a pregnancy complicated by preeclampsia had a higher risk of hypertension, reduced eGFR, and albuminuria compared with individuals without preeclampsia.