History of gestational diabetes mellitus or hypertensive disorders of pregnancy and risk of chronic kidney disease

Abstract

Aim: Chronic kidney disease (CKD) is a growing global concern, yet the long-term renal effects of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) remain unclear. This study evaluated the associations between GDM or HDP (GDM/HDP) history and CKD risk.

Methods: We used UK Biobank data to perform cross-sectional and prospective analyses. GDM and HDP were identified from self-reports or International Classification of Diseases, Tenth Revision (ICD-10) codes. Multivariable logistic, linear, and Cox regression models were used to assess associations with prevalent CKD and with renal function markers [estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), urate, creatinine], and incident CKD, respectively.

Results: At baseline, 172,133 women were included in the cross-sectional analysis. Prior GDM/HDP was associated with a higher likelihood of prevalent CKD [odds ratio, 1.26; 95% confidence interval (CI): 1.11-1.43] and higher UACR; GDM was also associated with higher eGFR and lower urate and creatinine. In a prospective analysis of 160,635 women over a median follow-up of 14.5 years, GDM/HDP was associated with an increased incident risk of CKD [hazard ratio (HR), 1.33; 95%CI: 1.12-1.59]. GDM alone showed a stronger association with incident CKD (HR: 1.82; 95%CI: 1.39-2.40). In subgroup analyses, the associations of GDM/HDP, GDM, and HDP with incident CKD remained largely consistent across strata of age, body mass index (BMI), baseline eGFR, and major chronic conditions.

Conclusion: Prior GDM/HDP was associated with subsequent subclinical and clinical renal impairment, supporting the inclusion of reproductive history in CKD risk assessment and the need for targeted prevention and long-term monitoring.

Keywords

Hypertensive disorders of pregnancy / gestational diabetes mellitus / chronic kidney disease / cohort study

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