Preeclampsia and its Long-term Impact on Chronic Kidney Disease
In the realm of women’s health, a concerning and intricate relationship exists between pregnancy-related complications and the development of chronic kidney disease (CKD). The complexities of this interplay demand our attention, particularly for women with health issues, as early detection and management could be pivotal in reducing the risk of CKD and cardiovascular problems.
Women who experience preeclampsia during pregnancy may unknowingly set the stage for future health challenges. Dr. Nityasree Srialluri and her colleagues from the division of nephrology at the Johns Hopkins School of Medicine shed light on this issue. Their study examined the cases of 27,800 women with deliveries in the Geisinger Health System between 1996 and 2019.
Preeclampsia, characterized by new-onset hypertension and organ damage, significantly raises the risk of developing CKD. However, the problem goes beyond pregnancy, as pregnant individuals with preeclampsia are also at heightened risk for future hypertension, reduced kidney function, and albuminuria. Shockingly, post-preeclampsia monitoring remains alarmingly low, suggesting an urgent need for better strategies.
For women with existing CKD, the challenges are even greater. The diagnosis of superimposed preeclampsia on CKD is intricate due to shared features between the two conditions. While studies have highlighted the increased risk of proteinuria and CKD progression during and immediately post-pregnancy, research on long-term outcomes for CKD patients is limited.
During the study period, only a fraction of women with deliveries, both with and without preeclampsia, underwent post-partum testing. This deficiency in monitoring creates a substantial gap in our understanding of the long-term effects of preeclampsia on CKD. To address this, it is imperative to establish optimal post-preeclampsia monitoring strategies.
On a positive note, recent advancements offer hope. The FDA granted authorization for the B·R·A·H·M·S sFlt-1/PlGF KRYPTOR Test System, which can identify women at high risk for preeclampsia. This innovation is especially valuable for CKD patients, where distinguishing between preeclampsia and worsening kidney disease is challenging.
Women’s health issues and kidney disease form a challenging crossroads, exacerbated by a lack of comfort among nephrologists in discussing these matters with patients. A survey highlighted the discomfort many nephrologists experience when addressing health concerns unique to women with kidney disease.
The survey also exposed a concerning lack of training among nephrologists in counseling women on these health issues. This gap in knowledge and confidence can have far-reaching consequences, affecting risk assessments for future pregnancies and chronic disease development.
Considering the rising rates of obesity and older maternal age, women are increasingly vulnerable to preeclampsia, especially those with underlying CKD. This highlights the urgent need for comprehensive care and early intervention.
Recognizing the need for a global perspective, the Kidney Disease: Improving Global Outcomes (KDIGO) held a conference focused on women’s health issues and nephrology. Experts from various fields, including nephrologists, obstetricians, and dietitians, discussed sex and gender disparities in kidney care, reproductive health, and pregnancy complications in women with CKD.
The future looks promising, as the KDIGO work group is expected to release a comprehensive report on these critical issues early next year. As we move forward, it’s essential to prioritize women’s health and kidney disease as interconnected facets of overall well-being.