Preeclampsia and ESRD: The Role of Shared Risk Factors

Am J Kidney Dis. 2017 Apr;69(4):498-505. doi: 10.1053/j.ajkd.2016.07.034. Epub 2016 Oct 1.


Background: Several registry-based studies, using diagnostic codes, have suggested that preeclampsia is a risk factor for end-stage renal disease (ESRD). However, because the 2 diseases share risk factors, the true nature of their association remains uncertain. Our goals were to conduct a population-based study to determine the magnitude of the association between preeclampsia and ESRD and evaluate the role of shared risk factors.

Study design: Population-based nested case-control study.

Setting & participants: The US Renal Data System was used to identify women with ESRD from a cohort of 34,581 women who gave birth in 1976 to 2010 in Olmsted County, MN. 44 cases of ESRD were identified and each one was matched to 2 controls based on year of birth (±1 year), age at first pregnancy (±2 years), and parity (±1 or ≥4).

Predictor: Preeclamptic pregnancy, confirmed by medical record review.

Outcome: ESRD.

Measurements: Prepregnancy serum creatinine and urine protein measurements were recorded. Comorbid conditions existing prior to pregnancy were abstracted from medical records and included kidney disease, obesity, diabetes, and hypertension.

Results: There was evidence of kidney disease prior to the first pregnancy in 9 of 44 (21%) cases and 1 of 88 (<1%) controls. Per chart review, 8 of 44 (18%) cases versus 4 of 88 (5%) controls had preeclamptic pregnancies (unadjusted OR, 4.0; 95% CI, 1.21-13.28). Results were similar after independent adjustment for race, education, diabetes, and hypertension prior to pregnancy. However, the association was attenuated and no longer significant after adjustment for obesity (OR, 3.25; 95% CI, 0.93-11.37).

Limitations: The limited number of ESRD cases and missing data for prepregnancy kidney function.

Conclusions: Our findings confirm that there is a sizable association between preeclampsia and ESRD; however, obesity is a previously unexplored confounder. Pre-existing kidney disease was common, but not consistently coded or diagnosed.

Keywords: Preeclampsia; end-stage renal disease (ESRD); hypertension; hypertensive pregnancy disorders; obesity; pregnancy; risk factor; toxemia.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cohort Studies
  • Comorbidity
  • Creatinine / blood
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis*
  • Kidney Failure, Chronic / etiology*
  • Kidney Function Tests
  • Obesity / complications
  • Obesity / diagnosis
  • Pre-Eclampsia / diagnosis*
  • Pre-Eclampsia / etiology*
  • Pregnancy
  • Recurrence
  • Risk Factors
  • Statistics as Topic
  • Young Adult


  • Creatinine