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 admission560,778n/a1.16 (1.10-1.24)1.11 (1.07-1.14)
Maternal age per 5yr560,778n/a1.33 (1.18-1.50)1.15 (1.04-1.28)
CKD2281842.1473.9 (318.1-578.3)37.5 (23.6-59.6)
Chronic HT3,123124.949.8 (28.17-88.03)ns
Pre-existing diabetes1,376174.443.38 (29.23-64.41)1.69 (1.21-2.36)
GH/Pre-eclampsia (HDP)36,30974.616.05 (4.69-12.27)12.32 (9.63-15.76)
Sepsis22,63140.77.59 (4.69-12.27)7.32 (5.32-10.08)
Postpartum haemorrhage73,58920.12.76 (2.01-3.8)2.33 (1.86-2.92)
Caesarean delivery155,73418.23.22 (2.15-4.83)2.02 (1.54-2.64)
Prematurity <33 weeks13,49154.847.27 (5.68-9.31)not entered
Critical Care admission1,412687.0153.4 (95.9-245.4)not entered

*All covariates adjusted for. OR p<0.005 for all variables