Abstract: FR-PO091
AKI in Pregnancy and the Puerperium
Session Information
- AKI Clinical: Predictors
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
Authors
- Brumby, Catherine, Monash University, Melbourne, Victoria, Australia
- Duke, Graeme, Monash University, Melbourne, Victoria, Australia
- Low, Elizabeth, Monash University, Melbourne, Victoria, Australia
- McMahon, Lawrence P., Monash University, Melbourne, Victoria, Australia
Background
Acute kidney injury (AKI) either during pregnancy or postpartum is associated with significant maternal and neonatal morbidity. Past population-based studies (1999-2011) in US and Canada suggest the incidence may be increasing, with contributing factors including increasing rates of hypertensive disorders of pregnancy (HDP) and CKD. We aim to determine recent developments in this apparent trend.
Methods
All public hospital admissions with pregnancy >20 weeks gestation in Victoria, Australia (2006-2016) were identified by ICD-10 diagnostic codes from a validated administrative database. Analysis included 560,778 antenatal and postpartum admissions, of which 533,876 included delivery. Trends in AKI incidence and associated risk factors were examined, and multivariate logistic regression determined whether changes in risk factors explained observed temporal changes.
Results
The incidence of AKI per 10,000 deliveries rose from 2.37 in 2006 to 11.59 in 2016, p<0.001. Of the 499 AKI cases, 228(45.6%) also had CKD, 22(4.4%) required renal replacement therapy, and 3(0.6%) died. The strongest risks factors associated with AKI were CKD, HDP, diabetes, and critical care admission. After adjustment, the temporal relationship for AKI risk was maintained, with risk factors being CKD, HDP, and sepsis.
Conclusion
The incidence of obstetric-related AKI continues to rise. This trend persists after adjusting for factors such as HDP, CKD and maternal age. Other, as yet unidentified or unmeasured factors may be implicated, such as greater awareness and reporting of AKI and increasing complexity of maternal comorbidities. Longterm risks of obstetric-related AKI remain to be determined.
Risk Factors Assocated with Obstetric AKI: Logistic Regression Analysis
| Risk Factor associated with AKI | Deliveries, number | AKI rate per 10,000 deliveries | Unadjusted OR (95% CI) | Adjusted OR* (95% CI) |
| Year of admission | 560,778 | n/a | 1.16 (1.10-1.24) | 1.11 (1.07-1.14) |
| Maternal age per 5yr | 560,778 | n/a | 1.33 (1.18-1.50) | 1.15 (1.04-1.28) |
| CKD | 228 | 1842.1 | 473.9 (318.1-578.3) | 37.5 (23.6-59.6) |
| Chronic HT | 3,123 | 124.9 | 49.8 (28.17-88.03) | ns |
| Pre-existing diabetes | 1,376 | 174.4 | 43.38 (29.23-64.41) | 1.69 (1.21-2.36) |
| GH/Pre-eclampsia (HDP) | 36,309 | 74.6 | 16.05 (4.69-12.27) | 12.32 (9.63-15.76) |
| Sepsis | 22,631 | 40.7 | 7.59 (4.69-12.27) | 7.32 (5.32-10.08) |
| Postpartum haemorrhage | 73,589 | 20.1 | 2.76 (2.01-3.8) | 2.33 (1.86-2.92) |
| Caesarean delivery | 155,734 | 18.2 | 3.22 (2.15-4.83) | 2.02 (1.54-2.64) |
| Prematurity <33 weeks | 13,491 | 54.84 | 7.27 (5.68-9.31) | not entered |
| Critical Care admission | 1,412 | 687.0 | 153.4 (95.9-245.4) | not entered |
*All covariates adjusted for. OR p<0.005 for all variables