Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis

Abstract

BackgroundPresently, the matter of pregnancy outcomes of patients with pregnancy related AKI (PR-AKI) were disputed. Thus, we conducted a meta-analysis to evaluate the impact of PR-AKI on pregnancy outcomes.MethodWe systematically searched MEDLINE, Embase, VIP, CNKI and Wanfang Databases for cohort or case-control studies in women with PR-AKI and those without AKI as a control group to assess the influence of PR-AKI on pregnancy outcomes and kidney outcome. Reduction of odd ratio (OR) was calculated by a random-effects model.ResultsOne thousand one hundred fifty two articles were systematically reviewed, of those 11 studies were included, providing data of 845 pregnancies in 834 women with PR-AKI and 5387 pregnancies in 5334 women without AKI. In terms of maternal outcomes, women with PR-AKI had a greater likelihood of cesarean delivery (OR, 1.49; 95% confidence interval [CI], 1.37 to 1.61), hemorrhage (1.26; 1.02 to 1.56), HELLP syndrome (1.86; 1.41 to 2.46), placental abruption (3.13; 1.96 to 5.02), DIC (3.41; 2.00 to 5.84), maternal death (4.50; 2.73 to 7.43), but had a lower risk of eclampsia (0.53; 0.34 to 0.83). Women with PR-AKI also had a longer stay in ICU (weighted mean difference, 2.13 day [95% CI 1.43 to 2.83 day]) compared with those without PR-AKI. As for fetal outcomes, higher incidence of stillbirth/perinatal death (3.39, 2.76 to 4.18), 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 -1180 to 310 g]) were observed in women with PR-AKI. The occurrence of kidney outcome, defined as ESRD requiring dialysis, in women with PR-AKI was 2.4% (95% CI 1.3% to 4.2%).ConclusionsPR-AKI remains a grave complication and has been associated with increased maternal and fetal mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1402-9) contains supplementary material, which is available to authorized users.

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

“…Риск повышения скорости прогрессирования ХБП создает серьезные этиче-ские проблемы, касающиеся наступления и про-лонгирования беременности [6][7][8]. Мы знаем, что ПЭ повышает вероятность развития артериальной гипертензии и ХБП в отдаленном периоде, но мы не знаем, могут ли наблюдение и ренопротектив-ные методы затормозить прогрессирующую поте-рю функции почек, и если могут, то каким образом [9][10][11][12].…”

“…Значение здоровья женщин для «почечного здоровья» в настоящем и будущем Что мы знаем ПЭ признается основной причиной ОПП и ма-теринской смертности в развивающихся стра-нах [2,17]. Беременность -самая частая причина ОПП у женщин детородного возраста [10,18,19]. Помимо ПЭ различные заболевания и состояния могут приводить к развитию ОПП, ассоцииро-ванного с беременностью.…”

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“…(2,17). Pregnancy is the most common cause of AKI in women of childbearing age (10,18,19). Several diseases and conditions, besides PE, hypertensive disorders of pregnancy, and CKD, can lead to pregnancy-related AKI.…”

What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

“…The risks increase with CKD progression thus posing potentially challenging ethical issues around conception and maintaining of pregnancies [6][7][8]. We do know that PE increases the probability of hypertension and CKD in later years, but we have not evaluated a surveillance or reno-protective strategy to determine if progressive loss of kidney function can be attenuated [9][10][11][12]. Specific systemic conditions like systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic scleroderma (SS), are more likely to affect women than men.…”