Study Finds Statistically Significant Risk of Developing CKD, ESKD Following Preeclampsia

Pregnancy complicated by preeclampsia has long raised concerns about future kidney health, particularly among women with or at risk for chronic kidney disease (CKD) and end-stage kidney disease (ESKD). A recent systematic review and meta-analysis found a statistically significant association between preeclampsia and an increased risk of developing CKD and ESKD later in life, while also highlighting uncertainty around causality and the need for targeted postpartum monitoring rather than routine long-term follow-up in otherwise healthy women.

Preeclampsia and Pregnancy With CKD

Pregnancy with kidney disease or transplant requires careful planning, warns the National Kidney Foundation. The stage of CKD, general health, age, having comorbidities (eg, hypertension, diabetes, heart disease), and protein in the urine can affect a healthy pregnancy. Prior to pregnancy, it is important that risk, treatments, and health impacts are discussed with a health care professional or specialist. Specifically, prior research suggests that women with very mild kidney disease (stages 1 and 2), normal blood pressure, and little or no protein in the urine can have a healthy pregnancy, but for those with moderate to severe kidney disease (stages 3–5), the risk of complications is much greater. The National Kidney Foundation recommends that, for some women, the risk to mother and child is high enough that they should consider avoiding pregnancy.²

Preeclampsia is a complication of pregnancy. People with preeclampsia might have high blood pressure, high levels of protein in the urine that indicate kidney damage (proteinuria), or other signs of organ damage. Usually, preeclampsia begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range. When left untreated, preeclampsia can lead to serious—and sometimes fatal—complications for both the mother and the baby. Early delivery of the baby is often recommended, but the timing of delivery depends on how severe preeclampsia is and how many weeks pregnant the mother is.³

Prior to delivery, preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications. At times, preeclampsia may develop after delivery of a baby, a condition known as postpartum preeclampsia.³

What Did the Study Evaluate?

Although previous studies and meta-analyses found an association between preeclampsia and CKD or ESKD later in life, it is unclear whether this relationship is causal. Additionally, prior data did not consistently exclude women with chronic hypertension and/or kidney disease prior to pregnancy, meaning that there is a possible selection bias. For these reasons, the study authors conducted a systematic review of the updated literature on renal outcomes in women who were healthy prior to pregnancy and experienced preeclampsia.¹

The investigators searched PubMed-MEDLINE and Embase for eligible studies. For the review, both retrospective and prospective studies that enrolled healthy women with preeclampsia and reported kidney outcomes were included. Among the 2796 titles originally screened, 9 studies met the inclusion criteria and were evaluated in the final analysis. Additionally, a random effects meta-analytic model was used for statistical analysis.¹

According to the investigators, a statistically significant increase in the risk of developing CKD and ESKD later in life following preeclampsia was found (CKD risk ratio: 1.83 [95% CI 1.16–2.89]; ESKD risk ratio: 8.96 [95% CI 4.94–16.23]), with high statistical heterogeneity. However, the only prospective study did not find a significant association between pre-eclampsia and chronic kidney disease.¹

Although there was a significant association identified, its clinical relevance and causality remain unclear, explained the authors. Postpartum medical investigation in women affected by preeclampsia is essential, but long-term follow-up may not be indicated in the absence of underlying or comorbid conditions. Based on their conclusion, the authors suggest that women who suffered from preeclampsia should be monitored regularly for 1 year postpartum; however, in the absence of any signs of renal involvement or hypertension, they should be considered clinically healthy and not at elevated long-term risk for CKD and/or ESKD.¹

“Most of the studies included in our meta-analysis had large sample size, were longitudinal and had low risk of bias. However, an underlying bias due to the mostly retrospective nature of the studies must be considered, and the possibility of bias due to misclassification of exposure, outcome, or covariate (as well as missing data in the registries used) exists in all studies selected,” the authors explained. “Another limiting factor of our research is the possible inclusion of some studies involving populations with other conditions that may lead to long-term kidney damage, such as diabetes and/or autoimmune diseases. It has also been suggested that the severity of pre-pregnancy renal function impairment, rather than the etiology of the renal disease itself, is a risk factor for PE and for accelerated progression of CKD.”¹

REFERENCES

1. Bianchi G, Vogt B, Bargagli M, Ferrier C. The dilemma of chronic kidney disease and end-stage kidney disease following pre-eclampsia: a literature review and meta-analysis. Int Urol Nephrol. 2025;57:4131-4140. doi:10.1007/s11255-025-04591-2

2. National Kidney Foundation. Pregnancy and Kidney Disease. Accessed January 15, 2026. https://www.kidney.org/kidney-topics/pregnancy-and-kidney-disease

3. Mayo Clinic. Preeclampsia. Accessed January 15, 2026. https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745