# Impact of Preeclampsia on Long-Term Kidney Function in a Low-Resourced Setting

## TL;DR

This study shows that preeclampsia leads to long-term kidney problems in women from a low-resource setting in South Africa.

## Contribution

The study provides new evidence on long-term kidney outcomes after preeclampsia in a low-income setting.

## Key findings

- Cardio-renal issues after preeclampsia were common, with over 40% of women still having hypertension at 2 years.
- Pregnancy-related acute kidney injury predicted reduced kidney function and albuminuria at 1 year.
- HIV and high BMI were significant risk factors for kidney dysfunction and hypertension, respectively.

## Abstract

Hypertensive disorders of pregnancy (HDPs) affect approximately 10% of pregnancies, with disproportionate morbidity and mortality in low- and middle-income countries. Although long-term cardiovascular and kidney sequelae of preeclampsia are established in high-income settings, data from low- and middle-income countries remain scarce. We assessed incident hypertension, kidney dysfunction, and albuminuria following preeclampsia and associated risk factors.

A prospective cohort study was conducted at Groote Schuur Hospital, South Africa, from January 2020 to October 2024. Clinical, demographic, and biochemical data were collected at delivery, first follow-up, and at 1- and 2-year visits. Logistic regression was used to assess predictors of hypertension, reduced estimated glomerular filtration rate (eGFR), and albuminuria, at time points stated above.

Of 241 women enrolled, 93 and 34 completed 1- and 2-year follow-up, respectively. The median age was 30 years (interquartile range [IQR]: 25–35), 50% had pregnancy-related acute kidney injury (AKI, Pr-AKI) and liver injury. Most (65%) delivered before 34 weeks. Incident hypertension persisted in 44% at first visit, 47% at 1 year, and 45% at 2 years. Reduced eGFR (< 90 ml/min per 1.73 m2) occurred in 22% at first visit and 20% at 1-year. Albuminuria persisted in > 50%. Pr-AKI predicted reduced eGFR (P = 0.013) and albuminuria (P = 0.015) at 1 year. HIV predicted reduced eGFR at first visit (P = 0.001), whereas elevated body mass index (BMI) predicted hypertension at 1 year (odds ratio [OR]: 3.98, P = 0.036).

Cardio-renal sequelae following preeclampsia were strikingly common, underscoring the need for integrated postpartum surveillance. In this cohort, Pr-AKI was an important determinant of chronic kidney disease (CKD).