Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil

Silva, Geraldo Bezerra da; Monteiro, Francisco Amaury; Mota, Rosa Maria Salani; Paiva, José Gerardo Araújo; Correia, José Walter; Filho, José Gomes Bezerra; Macedo, Rafael Nogueira de; Lima, Rafael Siqueira Athayde; Daher, Elizabeth F.

doi:10.1007/s00404-008-0682-8

Cited by 34 publications

(32 citation statements)

References 27 publications

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“…These findings are in keeping with known pathophysiologic mechanisms of AKI and two recent studies of severe cases of pregnancy-related AKI from Brazil and Egypt, defined by treatment with dialysis and AKI criteria within admission to the intensive care unit, respectively. 8,9 Preeclampsia was the most prevalent medical complication among women with AKI-D in our cohort and the most frequent medical complication recorded among women initiated on dialysis in the postpartum period. Preeclampsia is the leading cause of maternal morbidity and mortality worldwide, and a major contributor to premature births and intrauterine growth restriction.…”

Section: Discussionmentioning

confidence: 84%

“…8 Previous population-based reports on pregnancy-related AKI refer almost exclusively to secular trends in infection-related first-trimester AKI coinciding with the legalization of abortion and improved obstetrical care in low-income countries. 1,12 Pregnancies in high-income regions are more frequently complicated by hypertensive disorders of pregnancy, gestational diabetes, postpartum hemorrhage, and postpartum fever of To comply with privacy regulations for minimizing the chance of identification of a study participant, numbers of participants are suppressed in the case of five or fewer participants (reported as #5).…”

Section: Discussionmentioning

confidence: 99%

“…Maternal mortality was 4% and fewer than 4% of women remained dialysis dependent after 12 weeks postpartum, compared with previous studies indicating that maternal mortality associated with AKI-D in pregnancy may be as high as 30%, with up to 50% of survivors remaining dependent on chronic dialysis. 1,8 However, these studies represent single-center experiences prone to selection biases.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11] Other reports fail to characterize AKI in the context of patient demographics, standards of health care delivery, and physician practice patterns. 1 We conducted the present study to describe the incidence and outcomes of the most severe cases of AKI in pregnancy, namely, those treated with dialysis.…”

mentioning

confidence: 99%

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Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Hildebrand

Liu

Shariff

et al. 2015

Journal of the American Society of Nephrology

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Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997-2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (,2500 g), small for gestational age, or preterm birth (,37 weeks' gestation) were more common in pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (,2.7%) in affected pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes. 26: 3085-3091, 201526: 3085-3091, . doi: 10.1681 Pregnancy-related AKI is associated with significant morbidity and mortality inyoung and often otherwise healthy women. 1,2 Since the 1960s, the incidence of pregnancy-related AKI in developed countries has declined from 1 in 3000 to 1 in 18,000. 1 This trend has been closely linked to improved obstetrical care and dramatic reductions in first-trimester AKI attributable to septic abortions. 2 However, these trends are less relevant in contemporary populations. The changing risk profile of pregnant North American women includes lower parity, older age, higher body mass index, and greater comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease, as well as increased use of reproductive technologies resulting in multiple gestations. These changes may have a unique impact on the incidence, etiology, and outcomes of pregnancy-related AKI. [3][4][5][6][7] J Am Soc Nephrol

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Hildebrand

Liu

Shariff

et al. 2015

Journal of the American Society of Nephrology

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“…One woman (the worst outcome in this series) developed malignant hypertension, with fetal growth restriction, preterm delivery at 29 weeks for fetal distress. Others due to maternal hypertension in this study were 2 abruption placentas and 2 women with acute pulmonary edema 13 .…”

Section: Discussionmentioning

confidence: 66%

Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

Suarez¹,

Costa²,

Parpinelli³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high-risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women. ResumoOBJETIVOS: Descrever os resultados maternos e neonatais de mulheres grávidas que estavam em tratamento de hemodiálise em um centro de referência no Sudeste brasileiro. MÉTODOS: Estudo retrospectivo e descritivo, com revisão de prontuários de todas as gestações em hemodiálise, acompanhadas no pré-natal especializado da região Sudeste do Brasil. RESULTADOS: Entre as 16 mulheres identificadas, 2 foram excluídas devido à perda de seguimento. Das 14 descritas, a hipertensão foi a causa mais frequente de insuficiência renal crônica (50% dos casos). A maioria (71,4%) realizava tratamento de hemodiálise há mais de um ano e todas elas foram submetidas a 5 ou 6 sessões por semana. Onze mulheres tinham hipertensão crônica, 1 das quais também era diabética, e 6 eram fumantes. Em relação às complicações da gravidez, 1 das mulheres hipertensas desenvolveu hipertensão maligna (com restrição de crescimento fetal e parto prematuro com 29 semanas), 2 tiveram edema pulmonar agudo e 2 apresentaram descolamento prematuro de placenta. O tipo de parto foi cesariana em 9 mulheres (64,3%). Todos os recém-nascidos tiveram Apgar aos cinco minutos maior que 7. CONCLUSÕES: Para melhorar os resultados perinatais e maternos de mulheres em hemodiálise, é importante ter uma abordagem multidisciplinar em centro de referência, um controle rigoroso da uremia, hemoglobina e pressão arterial materna, bem como acompanhar de perto o bem-estar fetal e a morbidade materna. Outra estratégia importante é a orientação adequada para contracepção nessas mulheres.Obste...

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Profile and outcomes of women with pregnancy‐related acute kidney injury requiring dialysis at a center in Ethiopia

Bekele

Ahmed

Aliyu³

et al. 2017

Intl J Gynecology & Obste

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Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil

Abstract: AKI is a rare but potential fatal complication in obstetric patients. RIFLE criteria seem to have association with mortality. There are important factors associated with oliguria and death, which must be prompt recognized to the institution of adequate therapeutic measures.

Cited by 34 publications

References 27 publications

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

Profile and outcomes of women with pregnancy‐related acute kidney injury requiring dialysis at a center in Ethiopia

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