Oriana De Marco, Chiara Ruotolo, Linda Njanjo, Chiara Mariani, Béatrice Mazé, Giulia Santagati, Antioco Fois, Marie Therese Chevé, Antoine Chatrenet, Mario Salomone, Massimo Torreggiani, Giorgina Barbara Piccoli
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Abstract
Background: The risk of kidney failure increases after preeclampsia (PE), further increasing after two or more episodes. Recurrence is variably estimated. The aim of this study was to assess the recurrence rate and its predictors in the setting of obstetric-nephrology follow-up of pregnancies after PE.
Methods: In a prospective study (2018-24), from 108 pregnancies with prior hypertensive disorders of pregnancy we selected 77 singleton deliveries after excluding twins, miscarriages, terminations, ongoing pregnancies, and drop-outs. PE recurrence and potential associated factors were tested in univariable and multivariable logistic regression models. Gestational age at time of delivery was analyzed using Kaplan-Meier curves and Cox regression. The diagnostic potential of angiogenic placental biomarkers (soluble FMS-like tyrosine kinase-1 and placental growth factor) was likewise tested.
Results: In the context of a high prevalence of previous preterm delivery (53.6%), PE recurrence was 42.9%. Furthermore, 19.5% of the women experienced other complications and only 37.7% had an uneventful pregnancy; 60.6% of recurrences occurred after the 37th gestational week (GW), making later delivery possible (median: 38 GW in the index pregnancy versus 35 GW in the previous pregnancy). The covariates associated with PE recurrence were chronic hypertension (OR 7.662, 95% CI 2.122-33.379) and having had a baby with a centile <10th (OR 7.049, 95% CI 1.56-41.027), while those associated with time to delivery were hypertension and maternal age. Being diagnosed with chronic kidney disease after a previous PE episode was not associated with a significantly increased risk of recurrent PE.
Conclusions: Risk of PE recurrence was high but delayed in this cohort on multidisciplinary follow-up. The question of whether a proactive approach to delivery can help to preserve long-term maternal kidney health is open.
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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