Abnormal renal function three months after delivery among pre-eclampsia survivors in Sub-Saharan Africa: a prospective cohort study in Uganda

Abstract

Pre-eclampsia, a significant contributor to maternal and newborn mortality and morbidity, is a common pregnancy-specific hypertensive disorder that affects multiple systems, including the renal system. The consequences of pre-eclampsia on the survivors’ kidneys may result in abnormal renal function post-delivery, ultimately leading to the onset of chronic kidney disease. Despite pre-eclampsia being very common in women of African ancestry, there are hardly any studies that have investigated its long-term consequences in women of sub-Saharan Africa. This study aimed to establish the incidence and factors associated with abnormal renal function three months after delivery among pre-eclampsia survivors in a peri-urban Ugandan setting. Between November 2018 and June 2019, we recruited a prospective cohort of 116 women who experienced pre-eclampsia. Clinical and laboratory information were gathered at both delivery and three months postpartum. The incidence of abnormal renal function among pre-eclampsia survivors was assessed based on those with an estimated glomerular filtration rate < 90 ml/min/1.73 m², determined using the CKD-EPI equation. Multivariate modified Poisson regression with robust standard errors was conducted to identify factors associated with abnormal renal function. A high incidence of abnormal renal function, amounting to 16.7%, was observed. The delivery of a male baby (aRR 4.404; 95% CI 1.436–13.504, p-value = 0.010) and the persistence of hypertension three months after delivery (aRR 2.849; 95% CI 1.067–7.601, p-value = 0.037) were independently associated with abnormal renal function three months post-delivery. A substantial proportion of women exhibit abnormal renal function three months following a pregnancy complicated by pre-eclampsia. It is imperative to prioritize long-term follow-up for survivors of pre-eclampsia in low- and middle-income settings, mirroring the attention given in high-income settings. This emphasis is essential for the prevention, early detection, and timely intervention in addressing chronic renal disease.