Pregnancy-Associated Acute Kidney Injury in Low-Resource Settings: Progress Over the Last Decade

Davidson, Bianca; Bajpai, Divya; Shah, Silvi; Jones, Erika; Okyere, Perditer; Wearne, Nicola; Gumber, Ramnika; Saxena, Nikhil; Osafo, Charlotte

doi:10.1016/j.semnephrol.2023.151317

Cited by 3 publications

(2 citation statements)

References 88 publications

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“…The significant improvement in obstetric care and reduction in septic abortions in recent decades may have contributed to the decrease in the burden of this problem worldwide [ 26 ]. The incidence of PR-AKI in our study is lower than reports from low- and middle-income countries (4-26%) and from some high-income countries (1-2.8%) [ 34 – 36 ]. Studies from India have shown that the incidence of AKI in pregnancy has decreased in relation to the total number of AKI cases over the last 30 years [ 37 , 38 ].…”

Section: Discussioncontrasting

confidence: 83%

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Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review

Berhe,

Teka,

Abraha

et al. 2024

BMC Nephrol

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Background Pregnancy-related kidney injury contributes to a high burden of acute kidney injury in low-resource settings and causes maternal and perinatal morbidity and mortality. Few studies have examined the impact of acute kidney injury in resource-limited countries, with very limited research on pregnancy-specific disorders in Ethiopia. This study aimed to determine the characteristics of pregnancy-related acute kidney injury, outcomes and associated factors. Methods A retrospective study was conducted to evaluate the clinical profile and maternal-fetal outcome of pregnancy-related acute kidney injury at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Maternal and fetal outcomes were analyzed using descriptive statistics. Multivariate logistic regression was used to determine the association between the dependent and independent variables. Results Of 27,350 mothers who delivered at Ayder Comprehensive Specialized Hospital between January 1, 2017, and December 31, 2021, a total of 187 women developed pregnancy-related acute kidney injury, a prevalence rate of 68 per 100,000 births. Preeclampsia, sepsis and pre-renal causes due to dehydration and hemorrhage were the most common causes of pregnancy-related acute kidney injury in this study. Hemodialysis was needed in 8.6% (n = 16) of patients. Of the 187 pregnancy-related acute kidney injuries, 143 (76.5%) recovered completely and 30 (16%) partially. The mortality rate was 7.5%. Preexisting chronic kidney disease (AOR = 30.13; 95% CI: 2.92, 310.84), use of vasoactive agents (AOR = 5.77; 95% CI: 1.47, 22.67), increase in creatinine per unit (AOR = 1.65; 95% CI: 1.11, 2.45) and complications related to acute kidney injury (AOR = 5.26; 95% CI: 1.73, 16.00) were determinants of the composite endpoints (partial renal recovery and death). Conclusions This study emphasizes acute kidney injury in resource-limited settings is a significant cause of maternal and fetal morbidity and mortality. The vast majority of patients with pregnancy-related acute kidney injury recovered completely from kidney injury. The main causes of pregnancy-related acute kidney injury were preeclampsia, sepsis and pre-renal associated with hemorrhage and dehydration. Preexisting renal disease, use of vasopressors, increase in creatinine per unit and complications associated with acute kidney injury were determining factors for concomitant fetomaternal mortality. Appropriate preventive strategies during prenatal care and prompt treatment are needed for pregnancy-related acute kidney injury.

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Section: Discussioncontrasting

confidence: 83%

“…Early detection and treatment of PR-AKI should favor good outcomes. However, outcome studies suggest that PR-AKI is associated with residual renal dysfunction [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review

Berhe,

Teka,

Abraha

et al. 2024

BMC Nephrol

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Maternal Mortality due to Pregnancy-Related Acute Kidney Injury (PRAKI); A Study of the Epidemiological Factors and Possible Solutions

Gautam,

Ahmed,

Mishra

et al. 2024

J Obstet Gynecol India

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Pregnancy-associated acute kidney injury as a hidden driver of Chronic kidney disease in developing countries

Meena,

Das,

Auradkar

et al. 2024

Preprint

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Introduction: Pregnancy-related AKI (PR-AKI), has profound maternal and fetal implications, including high mortality and long-term risks such as the development of chronic kidney disease (CKD). This systematic review aims to evaluate the burden of CKD owing to PR-AKI cases during follow-up in developing countries, particularly India. Methods: A systematic search of PubMed, Embase, and Cochrane databases was performed for Indian studies published between 2000 and June 2024. We included cross-sectional, retrospective, and prospective cohort studies that reported the incidence of PR-AKI, subsequent CKD, and dialysis dependency in Indian cohorts during follow-up. Details of etiology of PRAKI, and adverse fetal and maternal outcomes were also recorded. Only studies that provided follow-up kidney outcomes were considered. Results: A total of 25 studies comprising 2,306 participants were included in the analysis. The incidence of PR-AKI ranged from 1–12%. Sepsis was the most common cause of PR-AKI, accounting for up to 78% of cases, followed by hypertensive disorders, obstetric haemorrhage, and tropical etiologies. Hemodialysis was required in 20–85% of patients. CKD development during follow-up was observed in 12.8–35% of cases, with up to 30% remaining dialysis-dependent. Maternal mortality ranged from 2.5–34%, while perinatal mortality reached as high as 67.3%. Pre-term delivery rates varied between 13.9% and 58%. Conclusions: Up to one-third of PR-AKI patients may develop CKD and remain dialysis-dependent during follow-up. PR-AKI significantly impacts both maternal and fetal morbidity and mortality. Early prevention and prompt management by healthcare professionals are critical to improving outcomes in PR-AKI.

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Pregnancy-Associated Acute Kidney Injury in Low-Resource Settings: Progress Over the Last Decade

Cited by 3 publications

References 88 publications

Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review

Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review

Maternal Mortality due to Pregnancy-Related Acute Kidney Injury (PRAKI); A Study of the Epidemiological Factors and Possible Solutions

Pregnancy-associated acute kidney injury as a hidden driver of Chronic kidney disease in developing countries

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