Dr Arunima Jain1,2,3, Dr Erandi Hewawasam3,4,5, A/Prof Shilpa Jesudason3,5,6
1Department of Obstetric Medicine, Royal Hospital for Women, Sydney, Australia, 2School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia, 3Pregnancy and Kidney Research Australia, Adelaide, Australia, 4Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 5Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia, 6Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Adelaide, Australia
Biography:
Dr Arunima Jain is an early career Nephrologist, currently dual training in Obstetric Medicine at the Royal Hospital for Women in Sydney. She has been awarded a NHMRC Postgraduate Scholarship to pursue her PhD next year, which focuses on improving diagnosis and management of kidney disease in and beyond pregnancy.
Abstract:
Aim: To determine incidence of pregnancy-related acute kidney injury (PR-AKI) in an Australian cohort. Secondary objectives include comparison of maternal and fetal outcomes in women with and without PR-AKI.
Background: International data suggest an association between PR-AKI and adverse outcomes. [1-3] Limited Australian data describe PR-AKI and consequences.
Methods: Births ≥20 weeks gestation were identified in perinatal datasets (1991-2013) and linked with Australia and New Zealand Dialysis and Transplant Registry (1970-2016) and hospital admission datasets (until 2018). PR-AKI was identified in hospital datasets using International Classification of Diseases (ICD) codes.
Results: Of 1,964,794 pregnancies (1,172,017 women) with hospital diagnostic codes, 2,630 (0.13%) had PR-AKI during pregnancy or postpartum (<42 days after birth).
Women with PR-AKI were more likely to have pre-existing diabetes (2.2% vs 0.6%, p<0.001), chronic hypertension (2.8% vs 0.9%, p<0.001), gestational diabetes (7.3% vs 6.0%, p=0.008) and pregnancy-related hypertension (13.6% vs 4.3%, p<0.001).
Their babies were more likely to be born via caesarean section (48.6% vs 28.8%), preterm (<37 weeks, 20.5% vs 7.1%), have low birthweight (<2500 grams, 14.3% vs 5.4%), require special/intensive care (20.1% vs 14.7%), or experience neonatal death (0.62% vs 0.23%); p<0.001.
Overall, 23 women (0.9% of PR-AKI cohort) required dialysis during pregnancy or postpartum. Of these women, 16 did not require further kidney replacement therapy (KRT, chronic dialysis or kidney transplantation), with four continuing dialysis and an additional three eventually requiring KRT.
Long-term, 552 women commenced KRT after a birth event. Women with PR-AKI were more likely to require KRT within one (10.7% vs 3.5%) or three years (46.4% vs 15.9%) compared to non-PR-AKI counterparts; p<0.05.
Conclusions: This is the first Australian study to explore PR-AKI at a population level, supporting evidence that women with PR-AKI had relatively increased adverse pregnancy and fetal outcomes. This highlights need for PR-AKI recognition, follow-up and further prospective research.
Keywords
pregnancy, acute kidney injury (AKI), dialysis
References
1) Liu Y, Ma X, Zheng J, Liu X, Yan T. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2017;17(1):235. doi: 10.1186/s12884-017-1402-9.
2) Hildebrand AM, Liu K, Shariff SZ, Ray JG, Sontrop JM, Clark WF, et al. Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period. J Am Soc Nephrol. 2015;26(12):3085-91. doi: 10.1681/ASN.2014100954.
3) Taber-Hight E, Shah S. Acute kidney injury in pregnancy. Adv Chronic Kidney Dis. 2020;27(6):455-460. doi: 10.1053/j.ackd.2020.06.002.