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

Abstract

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

Pregnancy-related acute kidney injury: An analysis of 165 cases

“…As noted in other series,[212223] majority of PRAKI was observed in postpartum period or third trimester, and in primigravidas, a group known to be at high-risk for preeclampsia and eclampsia. [2425] Similar to our cohort, sepsis contributed 30–60% cases of PRAKI in other series from Indian subcontinent, in contrast to 11% in Western literature.…”

Acute Kidney Injury in Pregnancy

“…A recent Canadian report showed that AKI resulting in the need for dialysis occurred in 1 per 10000 pregnant women, where 4.3% of the women died compared to 0.01% of pregnant women with no kidney injury, and 3.9% remained on dialysis four months after delivery. 5 The most common reasons for AKI in this study included preeclampsia, thrombotic microangiopathy (TMA), heart failure, sepsis or postpartum hemorrhage. 5 A study from India, in contrast, showed that the mortality rate for pregnant women requiring dialysis was 18.3%, of which 9% remained on dialysis six months later, 6 with the most common reason for AKI being post-abortion sepsis.…”

“…5 The most common reasons for AKI in this study included preeclampsia, thrombotic microangiopathy (TMA), heart failure, sepsis or postpartum hemorrhage. 5 A study from India, in contrast, showed that the mortality rate for pregnant women requiring dialysis was 18.3%, of which 9% remained on dialysis six months later, 6 with the most common reason for AKI being post-abortion sepsis. A Chinese study, on the other hand, determined an incidence of 0.11% of pregnancy-related AKI, with no women requiring dialysis between the years 2004–2013.…”

Acute kidney injury in critically ill obstetric patients: a cross-sectional study in an intensive care unit in Northeast Brazil

“…23 These laboratory abnormalities are probably associated with liver disorders, coagulation disturbances and HELLP syndrome. 2,8,[24][25][26][27] Regarding treatment, the use of vasoactive drugs, antibiotics, diuretics and mechanical ventilation were more frequent among AKI patients, which reflect the clinical severity of these patients. Mechanical ventilation and use of vasoactive drugs are associated with maternal mortality according to previous studies.…”