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

Introduction: 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. Methods: 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. Results: 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 m Conclusion: 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).