Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study

Ayansina, Dolapo; Black, Corrinda; Hall, Susan J.; Marks, Angharad; Millar, Colin; Prescott, Gordon; Wilde, Katie; Bhattacharya, S.

doi:10.1016/j.preghy.2016.08.231

Cited by 51 publications

(61 citation statements)

References 14 publications

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“…2,3 A principal cause of maternal mortality 4 and a chief risk factor for both maternal and fetal morbidity worldwide, 5 the health risks of preeclampsia persist well beyond the index pregnancy. Women with a history of preeclampsia are at higher risk for developing diabetes mellitus, 6 stroke, 7 and cardiovascular 8 and renal diseases 9 in later life. This susceptibility to cardiorenal and metabolic diseases post-index pregnancy has been attributed to the pathophysiological mechanisms 10,11 initiated by the placental ischemia.…”

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confidence: 99%

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

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Mahdi

Chapman

et al. 2017

JAHA

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BackgroundPreeclampsia is a hypertensive syndrome that complicates 3% to 5% of pregnancies in the United States. Preeclampsia originates from an improperly vascularized and ischemic placenta that releases factors that drive systemic pathophysiology. One of these factors, soluble fms‐like tyrosine kinase‐1, is believed to sequester vascular endothelial growth factor (VEGF), leading to systemic endothelial dysfunction and hypertension. With the goal of targeting soluble fms‐like tyrosine kinase‐1 while simultaneously preventing fetal exposure to VEGF, we fused VEGF to elastin‐like polypeptide, a biopolymer carrier that does not cross the placental barrier (ELP‐VEGF).Methods and Results ELP‐VEGF restored in vitro endothelial cell tube formation in the presence of plasma from placental ischemic rats. Long‐term administered ELP‐VEGF in pregnant rats accumulated in maternal kidneys, aorta, liver, and placenta, but the protein was undetectable in the pups when administered at therapeutic doses in dams. Long‐term administration of ELP‐VEGF in a placental ischemia rat model achieved dose‐dependent attenuation of hypertension, with blood pressure equal to sham controls at a dose of 5 mg/kg per day. ELP‐VEGF infusion increased total plasma soluble fms‐like tyrosine kinase‐1 levels but dramatically reduced free plasma soluble fms‐like tyrosine kinase‐1 and induced urinary excretion of nitrate/nitrite, indicating enhanced renal nitric oxide signaling. ELP‐VEGF at up to 5 mg/kg per day had no deleterious effect on maternal or fetal body weight. However, dose‐dependent adverse events were observed, including ascites production and neovascular tissue encapsulation around the minipump.Conclusions ELP‐VEGF has the potential to treat the preeclampsia maternal syndrome, but careful dosing and optimization of the delivery route are necessary.

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confidence: 99%

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

Logue

Mahdi

Chapman

et al. 2017

JAHA

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“…[4] In a study in the UK, the number of ESKD events in normotensive patients' first pregnancy was 3.9%, gestational hypertension 5.2% and pre-eclampsia 7.5%. [3] However, these studies did not report the underlying cause of ESKD.…”

Section: Discussionmentioning

confidence: 99%

“…It is now abundantly clear that healthy women who develop pre-eclampsia are more likely to develop hypertension at a younger age (30 -40 v. 50 -60 years), have an up to 4-fold increased risk of cardiovascular disease, and are more likely to develop stroke, myocardial infarction, atrial fibrillation and end-stage chronic kidney disease (ESKD). [3][4][5][6] The mechanism underlying this association remains unclear. [7] There are two competing hypotheses.…”

Section: Researchmentioning

confidence: 99%

Hypertension in pregnancy: A future risk for chronic kidney disease in South Africa

Jones

Rayner

2019

S Afr Med J

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“…Relatively little is known about its long-term effects on the kidney function later in life, and data available reveal conflicting results. While some studies report kidney dysfunction can be resolved in most women with a history of PE [10][11][12][13], it has been shown that some women with PE may experience decreased GFR and/or persistent proteinuria and/or increased risk of CKD after PE [9,[14][15][16][17][18], discrepancies which may be partly explained by differences in ethnicities, study design, definition of kidney function, and limited follow-up durations after pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Preeclampsia and the Ten-Year Risk of Incident Chronic Kidney Disease

et al. 2020

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Background: Although preeclampsia (PE), as an endothelial disorder can lead to renal dysfunction during pregnancy, results of studies focusing on the potential long-term potential effects of PE on renal function are insufficient and those available are controversial. This study investigated the incidence rate and risk of chronic kidney disease (CKD) among women with prior history of PE compared with healthy controls in a long-term population-based study. Methods: This was a prospective population-based cohort study. Subjects were 1,851 eligible women, aged 20-50 years, with at least 1 pregnancy (177 women with prior-PE and 1,674 non-PE controls) selected from among the Tehran-Lipid and Glucose-Study-participants. A pooledlogistic-regression-model and Cox's-proportional-hazards-models were utilized to estimate the risk of CKD in women of both PE and without PE groups, after further adjustment for confounders. Results: Median and interquartile ranges for follow-up durations of the PE and non-PE groups were 7.78 (5.19-10.40) and 7.32 (4.73-11.00) years, respectively. Total cumulative incidence rates of CKD at the median follow-up time of each group were 35/100,000 (95% CI 25/100,000-50/100,000) and 36/100,000 (95% CI 32/100,000-39/100,000) in PE and non-PE women, respectively (p value = 0.90). Based on pooled-logistic-regression-analysis, OR of CKD progression (adjusted for age, body mass index [BMI], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) for the PE group did not differ, compared to their non-PE counterparts (OR 1.04; p value = 0.80; 95% CI 0.77-1.40). Compared to non-PE women, wom-en with prior PE did not have higher hazard ratios (HRs) of developing CKD in the unadjusted model (unadjusted HR 1.1, 95% CI 0.83-1.69, p = 0.35), results which remained unchanged after adjustment for age, BMI, baseline SBP, and DBP. Conclusion: PE was not found to be a risk factor for CKD. More studies using a prospective cohort design with long-term follow-ups are needed to investigate the relationship between preeclamsia and CKD.

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Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study

Cited by 51 publications

References 14 publications

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

A Maternally Sequestered, Biopolymer‐Stabilized Vascular Endothelial Growth Factor (VEGF) Chimera for Treatment of Preeclampsia

Hypertension in pregnancy: A future risk for chronic kidney disease in South Africa

Preeclampsia and the Ten-Year Risk of Incident Chronic Kidney Disease

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