(616) Preeclampsia compared to gestational hypertension increases short-term renal disease morbidity

Despite the physiologic differences, gestational hypertension and preeclampsia without severe features are managed similarly. We hypothesize that the presence of proteinuria in preeclampsia increases the risk of short-term renal disease morbidity.

Study Design: Using the Healthcare Cost and Utilization Project Nationwide Readmissions Database, we performed a retrospective cohort study of hospital delivery discharges in the United States from 2010 to 2020. We used ICD 9 and 10 codes to identify deliveries complicated by hypertensive disease in pregnancy, as well as hospital readmissions within the calendar year of delivery for renal disease, including acute and chronic kidney disease. Chronic hypertension and superimposed preeclampsia were excluded to avoid the possibility of baseline renal disease due to preexisting hypertension. Associations were derived from Cox proportional hazard models expressed in the confounder-adjusted hazard ratio (HR) with a 95% confidence interval (CI).

Results:

There were 3,425,221 deliveries complicated by gestational hypertension, preeclampsia without severe features, or severe preeclampsia. Renal disease hospitalization rates for gestational hypertension, preeclampsia without severe features, and severe preeclampsia were 247, 408, and 648 per 100,000 delivery hospitalizations, respectively. Compared to those with gestational hypertension, preeclampsia without severe features was associated with increased risks of acute renal disease (HR 1.49, 95% CI 1.31-1.68); risks for chronic renal disease were even higher (HR 2.31, 95% CI 1.70-3.13). Patients with severe preeclampsia were at substantially increased risk of renal disease hospitalizations.

Conclusion:

Preeclampsia has a 1.5- fold and severe preeclampsia a 2.4-fold increase in renal disease morbidity compared to gestational hypertension. These findings highlight the different prognoses between gestational hypertension, non-severe preeclampsia, and severe preeclampsia. Patients who have preeclampsia may warrant closer surveillance for long-term kidney disease.