Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia

Matthew J.L. Hare; Louise J. Maple-Brown; Jonathan E. Shaw; Jacqueline A. Boyle; Paul D. Lawton; Elizabeth L.M. Barr; Steven Guthridge; Vanya Webster; Denella  Hampton; Gurmeet Singh; Roland F. Dyck; Federica Barzi

doi:10.1007/s00125-023-05868-w

Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia

Matthew J.L. Hare, Louise J. Maple-Brown, Jonathan E. Shaw, Jacqueline A. Boyle, Paul D. Lawton, Elizabeth L.M. Barr, Steven Guthridge, Vanya Webster, Denella Hampton, Gurmeet Singh, Roland F. Dyck, Federica Barzi

Menzies School of Health Research

Research output: Contribution to journal › Article › peer-review

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Abstract

Aims/hypothesis: The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia.

Methods: We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression.

Results: Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]).

Conclusions/interpretation: Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.

Original language	English
Pages (from-to)	837-846
Number of pages	10
Journal	Diabetologia
Volume	66
Issue number	5
Early online date	18 Jan 2023
DOIs	https://doi.org/10.1007/s00125-023-05868-w
Publication status	Published - May 2023

Bibliographical note

Funding Information:
This project was supported by a Diabetes Australia Research Program General Grant. MJLH was supported by National Health and Medical Research Council (NHMRC) Postgraduate Scholarship (no. 1169091), Diabetes Australia and the Australian Academy of Science. LJMB and JES were supported by NHMRC Investigator Grants (no. 1194698 and no. 1079438). Funding bodies had no role in the study design, analysis, interpretation, manuscript preparation or decision to submit the manuscript for publication.

Publisher Copyright:
© 2023, The Author(s).

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s00125-023-05868-wAccepted author manuscript, 793 KBLicence: CC BY
68553633-oaFinal published version, 785 KBLicence: CC BY
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Hare, M. J. L., Maple-Brown, L. J., Shaw, J. E., Boyle, J. A., Lawton, P. D., Barr, E. L. M., Guthridge, S., Webster, V., Hampton, D., Singh, G., Dyck, R. F., & Barzi, F. (2023). Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia. Diabetologia, 66(5), 837-846. https://doi.org/10.1007/s00125-023-05868-w

@article{28074727db3d4b518db141c0db8203c1,

title = "Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia",

abstract = "Aims/hypothesis: The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia. Methods: We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression. Results: Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]). Conclusions/interpretation: Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed. ",

keywords = "Aboriginal Australians, Chronic kidney disease, Diabetes, gestational, End-stage kidney disease, Indigenous peoples, Oceanic Ancestry Group, Pregnancy complications, Pregnancy in diabetes, Type 2 diabetes",

author = "Hare, {Matthew J.L.} and Maple-Brown, {Louise J.} and Shaw, {Jonathan E.} and Boyle, {Jacqueline A.} and Lawton, {Paul D.} and Barr, {Elizabeth L.M.} and Steven Guthridge and Vanya Webster and Denella Hampton and Gurmeet Singh and Dyck, {Roland F.} and Federica Barzi",

note = "Funding Information: This project was supported by a Diabetes Australia Research Program General Grant. MJLH was supported by National Health and Medical Research Council (NHMRC) Postgraduate Scholarship (no. 1169091), Diabetes Australia and the Australian Academy of Science. LJMB and JES were supported by NHMRC Investigator Grants (no. 1194698 and no. 1079438). Funding bodies had no role in the study design, analysis, interpretation, manuscript preparation or decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = may,

doi = "10.1007/s00125-023-05868-w",

language = "English",

volume = "66",

pages = "837--846",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer",

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Hare, MJL , Maple-Brown, LJ, Shaw, JE, Boyle, JA, Lawton, PD , Barr, ELM, Guthridge, S, Webster, V, Hampton, D, Singh, G, Dyck, RF & Barzi, F 2023, 'Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia', Diabetologia, vol. 66, no. 5, pp. 837-846. https://doi.org/10.1007/s00125-023-05868-w

Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia. / Hare, Matthew J.L.; Maple-Brown, Louise J.; Shaw, Jonathan E. et al.
In: Diabetologia, Vol. 66, No. 5, 05.2023, p. 837-846.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Risk of kidney disease following a pregnancy complicated by diabetes

T2 - A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia

AU - Hare, Matthew J.L.

AU - Maple-Brown, Louise J.

AU - Shaw, Jonathan E.

AU - Boyle, Jacqueline A.

AU - Lawton, Paul D.

AU - Barr, Elizabeth L.M.

AU - Guthridge, Steven

AU - Webster, Vanya

AU - Hampton, Denella

AU - Singh, Gurmeet

AU - Dyck, Roland F.

AU - Barzi, Federica

N1 - Funding Information: This project was supported by a Diabetes Australia Research Program General Grant. MJLH was supported by National Health and Medical Research Council (NHMRC) Postgraduate Scholarship (no. 1169091), Diabetes Australia and the Australian Academy of Science. LJMB and JES were supported by NHMRC Investigator Grants (no. 1194698 and no. 1079438). Funding bodies had no role in the study design, analysis, interpretation, manuscript preparation or decision to submit the manuscript for publication. Publisher Copyright: © 2023, The Author(s).

PY - 2023/5

Y1 - 2023/5

N2 - Aims/hypothesis: The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia. Methods: We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression. Results: Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]). Conclusions/interpretation: Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.

AB - Aims/hypothesis: The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia. Methods: We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression. Results: Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]). Conclusions/interpretation: Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.

KW - Aboriginal Australians

KW - Chronic kidney disease

KW - Diabetes, gestational

KW - End-stage kidney disease

KW - Indigenous peoples

KW - Oceanic Ancestry Group

KW - Pregnancy complications

KW - Pregnancy in diabetes

KW - Type 2 diabetes

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U2 - 10.1007/s00125-023-05868-w

DO - 10.1007/s00125-023-05868-w

M3 - Article

AN - SCOPUS:85146392351

SN - 0012-186X

VL - 66

SP - 837

EP - 846

JO - Diabetologia

JF - Diabetologia

IS - 5

ER -

Risk of kidney disease following a pregnancy complicated by diabetes: A longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia

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