Abstract: TH-OR105

AKI Severity and Risk of Adverse Pregnancy Outcomes in Women with Recovered AKI

Session Information

  • Predicting AKI
    November 02, 2017 | Location: Room 282, Morial Convention Center
    Abstract Time: 05:54 PM - 06:06 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Tangren, Jessica Sheehan, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Wan Md Adnan, Wan Ahmad Hafiz, University Malaya, Kuala Lumpur, Malaysia
  • Ankers, Elizabeth D., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Thadhani, Ravi I., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

We previously reported that an episode of clinically recovered AKI (rAKI) before pregnancy was associated with increased rates of pregnancy complications including preeclampsia. Our initial study was not powered to determine if stage of AKI was associated with adverse outcomes. Using an expanded cohort of women with recovered AKI with 8 years of additional data, we aimed to identify if AKI severity prior to pregnancy was associated with adverse pregnancy outcomes.

Methods

We conducted a retrospective cohort study of women who delivered infants from 1998 to 2016 at the Massachusetts General Hospital. Pregnancy outcomes in women with a history of Stage 1 (S1, n=98), Stage 2 (S2, n=99) and Stage 3 (S3, n=49) AKI were compared to women without a history of AKI (controls, n=24,460).

Results

Pre-pregnancy serum creatinine measurements were similar between women with rAKI and controls (0.63 ± 0.1 vs 0.69 ± 0.1 mg/dl). Women with rAKI had an increased rate of preeclampsia (22% versus 4%, p<0.01). Infants of women with r-AKI were born earlier (38.2±3.1 vs. 39.2±2.2 weeks, p<0.01). Increasing AKI stage was associated with higher rates preterm delivery and preeclampsia (Table 1). Rates of IUGR were higher in women with rAKI but did not show a dose-response effect (p for trend = 0.40). After multivariate adjustment women with S3 AKI were at increased risk for preeclampsia compared to women with S1 AKI (OR 3.7 95%CI 1.5-9.1) Longer duration (years) from AKI to pregnancy was associated with decreased risk for preeclampsia (OR 0.7 95% CI 0.6-0.9).

Conclusion

Severity of AKI demonstrated a dose-response relationship with many adverse pregnancy outcomes. Longer duration between AKI episode and pregnancy was protective against adverse outcomes. Further research is needed to determine how best to counsel young women with AKI planning pregnancy.

Funding

  • Private Foundation Support