Epidemiology of acute kidney injury in hospitalized pregnant women in China

Abstract

Background Epidemiologic data of acute kidney injury (AKI) during pregnancy is lacking in China. This study aims to determine the effect of pregnancy on the risk of AKI among hospitalized women of childbearing age, and to describe the incidence, risk factors and outcomes of AKI in hospitalized pregnant women in China. Methods We previously conducted a nationwide, multi-centered cohort of hospitalized patients from 25 hospitals in China during 1/1/2013 to 31/12/2015. Women of childbearing age (14–50 year) who had at least two serum creatinine tests within any 7-day window were selected as analysis set. Patient-level data were obtained from the electronic hospitalization information system and laboratory databases. AKI events were identified according to the creatinine criteria of Kidney Disease Improving Global Outcomes. Results Among 110,873 women of childbearing age, pregnant women ( n = 10,920) had a 51% higher risk of AKI than non-pregnant women ( n = 99,953). Community acquired and hospital acquired AKI occurred in 3.6% ( n = 393) and 3.7% ( n = 402) of the pregnant women, respectively, giving rise to an overall AKI incidence of 7.3%. While, hospital coding would have identified less than 5% of AKI episodes. The top three risk factors of AKI during pregnancy, ranked in order of decreasing population attributable fractions were pregnancy-induced hypertension syndrome (21.1%), acute fatty liver (13.5%), and chronic kidney disease (6.2%). Conclusion AKI in pregnancy is associated with increased maternal mortality rate, longer length of stay and higher daily cost. AKI is a common and severe complication during pregnancy in China. Electronic supplementary material The online version of this article (10.1186/s12882-019-1255-8) contains supplementary material, which is available to authorized users.

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

“…Women with PR-AKI also had a longer stay in the ICU, a higher incidence of stillbirth/perinatal death, lower mean gestational age at delivery (−0.70 week [95% CI −1.21 to −0.19 week]) and lower birth weight (−740 g [95% CI −1,180 to 310 g] compared to women without PR-AKI (47). Similar trends have also been reported in more recent independent studies emphasizing the impact of PR-AKI on both maternal and fetal health (26,34).…”

“…The gestational age at which PR-AKI occurs can help elucidate the cause by considering the typical timing of the various obstetric complications. Additionally, a recent study by Liu et al, reported that compared to non-pregnant women, pregnant women had a 51% increased risk of developing AKI that was independent of age and clinical comorbidities, suggesting that pregnancy increases the risk of AKI (26).…”

“…Evidence suggests that hypertensive disorders of pregnancy are an important contributor to the burden of AKI in pregnancy, in particular preeclampsia and HELLP syndrome which are already associated with increased incidences of maternal and perinatal morbidity and mortality (35,(49)(50)(51). PR-AKI also has a significant impact on both maternal and fetal morbidity and mortality (26,47). A 2017 systematic review and meta-analysis looked at maternal and fetal outcomes in cases of PR-AKI.…”

“…Along with maternal complications, PR-AKI also has a significant impact on fetal morbidity and mortality (26,47). Mortality rate has been estimated to be 23.5-38% among babies born to women with PR-AKI (45-47).…”

Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

“…It affects approximately 5-17 % of patients with severe preeclampsia[ 4 , 9 , 21 ] and 7-60 % of patients with HELLP syndrome[ 9 , 22 , 23 ]. However, a recent study revealed that only 4.0 % of AKI events were initially diagnosed on the discharge record[ 24 ]. Patients at early stage of renal impairment sometimes present with Scr levels within normal range due to physiological glomerular hyperfiltration.…”