Preeclampsia is a valuable opportunity to diagnose chronic kidney disease: a multicentre study

Cabiddu, Gianfranca

First

Writing - Original Draft Preparation

;Mannucci, Claudia;Fois, Antioco;Maxia, Stefania;Chatrenet, Antoine;Osadolor, Sarah;Kimani, Emily;Torreggiani, Massimo;Attini, Rossella;Masturzo, Bianca;Cheve, Marie Therese;Piccoli, Giorgina Barbara

2022-01-01

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Abstract

Background: Preeclampsia (PE) and chronic kidney disease (CKD) are known to be associated. Our objective was to assess the prevalence CKD in a large multicenter cohort of women without acknowledged CKD who experienced a PE episode. Methods: Setting: France (Le Mans, Central France) and Italy (Cagliari, Sardinia).Participants: Patients who experienced PE in 2018-2019, identified from the obstetric charts. Patients with known-acknowledged CKD were excluded. Only singletons were considered.Persistent (micro)albuminuria was defined as present and confirmed at least 3 months after delivery. CKD was defined according to the KDOQI guidelines; urinary alterations or low eGFR confirmed at least 3 months of distance, or morphologic changes. Patients were divided into 4 groups: evidence of CKD; no evidence of CKD; unclear diagnosis-ongoing work-up; persistent microalbuminuria. The outcome "diagnosis of CKD" was analyzed by simple and multiple logistic regressions. Temporal series (week of delivery) were analyzed with Kaplan-Meier curves and Cox analysis. Results: Two-hundred-eighty-two PE pregnancies were analyzed (Le Mans: 162; Cagliari: 120). The incidence of CKD diagnosis was identical (Le Mans: 19.1%; Cagliari: 19.2%); no significant difference was found in unclear-ongoing diagnosis (6.2%; 5.8%) and microalbuminuria (10.5%; 5.8%). Glomerulonephritis and diabetic nephropathy were more frequent in Cagliari (higher age and diabetes prevalence), interstitial diseases in Le Mans. In the multivariate logistic regression, CKD diagnosis was associated with preterm delivery (adjusted p = 0.035). Gestation was one week shorter in patients diagnosed with CKD (Kaplan Meier p = 0.007). In Cox analysis CKD remained associated with shorter gestation after adjustment for age and parity. Conclusions: The prevalence of newly diagnosed CKD is high after PE (19% vs expected 3% in women in childbearing age), supporting a systematic nephrology work-up after PE.