Abstract: SA-PO039

Obstetric AKI and Renal Outcomes Secondary to Pre-Eclampsia

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Conti-Ramsden, Frances I, Kings College London, London, United Kingdom
  • Nathan, Hannah L, Kings College London, London, United Kingdom
  • De greeff, Annemarie, Accuracy Assessed Medical Devices CC, Diamond, South Africa
  • Steyn, Daniel Wilhelm, Stellenbosch University, Parow, South Africa
  • Hall, David, Stellenbosh University and Tygerberg Hospital, Cape Town, South Africa
  • Chappell, Lucy C., Kings College London, London, United Kingdom
  • Shennan, Andrew H, Kings College London, London, United Kingdom
  • Bramham, Kate, Kings College London, London, United Kingdom
Background

Introduction: Pre-eclampsia (PET) is a common cause of acute kidney injury (AKI) but AKI incidence, risk factors, maternal and renal outcomes in a middle-income setting are unknown. Objectives: To define the incidence of obstetric AKI in the CRADLE-II pre-eclampsia cohort, explore the association between maximal creatinine and maternal outcomes, and to identify the proportion of women with persistently elevated serum creatinine (Cr) before and after discharge.

Methods

A prospective observational study of women with PET at 3 centres in South Africa was conducted (Jan 2015-May 2016). Pre-specified outcomes were eclampsia, stroke, maximal Cr during admission ≥90 µmol/L (MaxCr90), maternal and perinatal death. Serial Cr (pre-pregnancy to May 2017) were subsequently extracted from national databases in all women with MaxCr90.

Results

272/1547 (17.6%) of women had MaxCr90 (median 114, range 90-1097). Relative risk of death in women with MaxCr90 was 6.2 (95% CI 2.2,17.8). 236 (15.2%) women had AKI (KDIGO criteria; 123 (52.1%) Stage 1; 63 (26.7%) Stage 2; 50 (21.2%) Stage 3) with 188/236 (79.7%) cases occurring within 48hrs of admission. 138 women (58.5%) had AKI recovery at discharge (Cr returned to <1.5x baseline or <90 µmol/L if no baseline), 92 women (39.0%) did not have AKI recovery at discharge (Cr >1.5x baseline or >90 µmol/L if no baseline) and 6 (2.5%) women died. Serum Cr was repeated post discharge in 25 (27.1%) women without AKI recovery: 19 (76%) had AKI recovery; 6 (24%) no recovery. Overall, 96.3% (157/163) of women with repeat Cr assessment had AKI recovery but 3.7% (6/162) did not. Repeat Cr was not assessed in 67/92 (72.8%) women without AKI recovery at discharge.

Conclusion

Obstetric AKI was common in women with PET in this middle-income cohort. Maximal Cr ≥90 µmol/L was associated with a significantly increased risk of maternal death. Approximately two in five women had persistently raised serum Cr at discharge, which was not subsequently repeated in almost three quarters of these women. However, recovery from obstetric AKI in those assessed was high. Few women had persistently raised Cr reflecting new or pre-existing chronic kidney disease (CKD). The long term impact of recovered obstetric AKI on future CKD development requires further study.

Funding

  • Private Foundation Support