An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

Abstract Women with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD a...

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Autores principales:	Maren Goetz, Mitho Müller, Raphael Gutsfeld, Tjeerd Dijkstra, Kathrin Hassdenteufel, Sara Yvonne Brucker, Armin Bauer, Stefanie Joos, Miriam Giovanna Colombo, Sabine Hawighorst-Knapstein, Ariane Chaudhuri, Gudula Kirtschig, Frauke Saalmann, Stephanie Wallwiener
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3814be623cb74475b4768596f52bd08c
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spelling	oai:doaj.org-article:3814be623cb74475b4768596f52bd08c2021-12-02T17:40:49ZAn observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia10.1038/s41598-021-92078-22045-2322https://doaj.org/article/3814be623cb74475b4768596f52bd08c2021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-92078-2https://doaj.org/toc/2045-2322Abstract Women with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.Maren GoetzMitho MüllerRaphael GutsfeldTjeerd DijkstraKathrin HassdenteufelSara Yvonne BruckerArmin BauerStefanie JoosMiriam Giovanna ColomboSabine Hawighorst-KnapsteinAriane ChaudhuriGudula KirtschigFrauke SaalmannStephanie WallwienerNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maren Goetz Mitho Müller Raphael Gutsfeld Tjeerd Dijkstra Kathrin Hassdenteufel Sara Yvonne Brucker Armin Bauer Stefanie Joos Miriam Giovanna Colombo Sabine Hawighorst-Knapstein Ariane Chaudhuri Gudula Kirtschig Frauke Saalmann Stephanie Wallwiener An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
description	Abstract Women with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.
format	article
author	Maren Goetz Mitho Müller Raphael Gutsfeld Tjeerd Dijkstra Kathrin Hassdenteufel Sara Yvonne Brucker Armin Bauer Stefanie Joos Miriam Giovanna Colombo Sabine Hawighorst-Knapstein Ariane Chaudhuri Gudula Kirtschig Frauke Saalmann Stephanie Wallwiener
author_facet	Maren Goetz Mitho Müller Raphael Gutsfeld Tjeerd Dijkstra Kathrin Hassdenteufel Sara Yvonne Brucker Armin Bauer Stefanie Joos Miriam Giovanna Colombo Sabine Hawighorst-Knapstein Ariane Chaudhuri Gudula Kirtschig Frauke Saalmann Stephanie Wallwiener
author_sort	Maren Goetz
title	An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
title_short	An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
title_full	An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
title_fullStr	An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
title_full_unstemmed	An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
title_sort	observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/3814be623cb74475b4768596f52bd08c
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An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

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