Preeclampsia and Long-Term Risk of CKD: Global Cohort Study Using Real-World Data

Background: Preeclampsia has been implicated in long-term cardiovascular and renal complications, but large-scale data quantifying its association with chronic kidney disease (CKD) are limited. We aimed to assess the incidence of moderate-to-severe CKD (stages 3–5) among women with a history of preeclampsia compared to those without. Methods: Using the TriNetX Global Collaborative Network (148 healthcare organizations), we identified women aged 18–45 with documented pregnancies. Cohort A (n = 106,144) included patients with preeclampsia or pre-existing hypertension with superimposed preeclampsia; Cohort B (n = 2,139,255) included pregnant women without hypertensive complications. Outcomes were evaluated from one day post-index event through the available follow-up period. The primary outcome was incidence of CKD stages 3–5 (ICD-10: N18.3–N18.5). Secondary outcomes included mortality, acute kidney injury (AKI), end-stage renal disease (ESRD), nephrotic syndrome, and nephritis. Kaplan-Meier survival curves, risk ratios (RR), and hazard ratios (HR) were calculated. Results: Compared to the control group, women with preeclampsia had significantly increased risk of CKD stages 3–5 (1.3% vs. 0.1%, RR 15.02; HR 16.31; p<0.001). Other renal complications were also more frequent in the preeclampsia group: AKI: 2.7% vs. 0.5% (RR 5.58; HR 6.04) ESRD: 0.8% vs. 0.1% (RR 15.44) Nephrotic syndrome: 0.4% vs. 0.03% (RR 10.91; HR 11.15) Nephritis: 0.6% vs. 0.1% (RR 10.41; HR 10.48) Mortality: 0.6% vs. 0.2% (RR 2.43; HR 2.69) Kaplan-Meier analysis confirmed significantly lower renal survival in the preeclampsia cohort. Median survival was not reached, but survival probability at end of follow-up was 92.5% for CKD-free survival vs. 98.6% in controls. Conclusion Conclusion: In this large, multicenter real-world cohort, preeclampsia was strongly associated with increased risks of CKD stages 3–5 and other serious renal outcomes. These findings underscore the need for long-term nephrology follow-up and risk-based screening protocols for women with a history of preeclampsia