Abstract: TH-PO0705
Characterizing Creatinine Kinetics in Pregnancy-Related AKI
Session Information
- AKI: Prevention, Diagnostics, and Management
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Rimawi, Asmaa, University of Michigan, Ann Arbor, Michigan, United States
- Cervantes, Lilia, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Neugarten, Joel, Montefiore Einstein Medical Center, New York, New York, United States
- Golestaneh, Ladan, Yale School of Medicine, New Haven, Connecticut, United States
Background
Acute kidney injury (AKI) in pregnancy is a distinct clinical entity due to physiologic changes in renal hemodynamics. Pregnancy-related AKI (PR-AKI) is unique in its association with pregnancy-specific events. Current Kidney Disease: Improving Global Outcomes (KDIGO) AKI criteria are commonly extrapolated to pregnancy despite limited data comparing creatinine changes and clinical outcomes between pregnant and non-pregnant women with AKI.
Methods
We conducted a retrospective cohort study of hospitalizations at Montefiore Medical Center from 10/2015 to 1/2019. Obstetric hospitalizations were classified as pregnancy related, while age-matched non-obstetric hospitalizations served as the non-pregnant comparator group. AKI was defined by KDIGO criteria. If a pre-admission baseline creatinine was unavailable, the lowest inpatient value was used. Descriptive and bivariate analyses were performed to compare groups.
Results
Among 46,248 hospitalizations in women aged 17–45 years, 23,868 (48.4%) were pregnancy related. AKI occurred in 2,310 patients (5.0%), and was less frequent in pregnancy-related hospitalizations than non-pregnant hospitalizations (3.2% vs 12.7%, p < 0.001). Among patients meeting AKI criteria, pregnant patients were younger (29.9 ± 6.6 vs 33.0 ± 8.4 years) and had a higher median body mass index (30.7 vs 26.9 kg/m2). Pregnancy-related AKI was associated with lower baseline creatinine (0.64 ± 0.23 vs 0.78 ± 0.7 mg/dL; p=0.002), lower peak creatinine (1.15 ± 0.44 vs 1.39 ± 1.28 mg/dL; p=0.07), and smaller absolute creatinine increases (0.50 ± 0.34 vs 0.61 ± 0.98 mg/dL; p<0.001) compared with non-pregnant AKI.
Pregnancy-related hospitalizations were associated with lower rates of ICU admission (4.0% vs 11.2%), mechanical ventilation (2.35% vs 5.47%), in-hospital mortality (0.34% vs 13.62%), and sepsis (4.8% vs 14.2%) (all p < 0.001).
Conclusion
Pregnant patients meeting KDIGO AKI criteria had smaller creatinine increases and lower baseline creatinine levels than non-pregnant women with AKI, suggesting that even small creatinine rises in pregnancy may warrant clinical attention. AKI definitions may underestimate PR-AKI severity, consistent with known morbidity associated with PR-AKI. Non-pregnant hospitalized women with AKI are not an appropriate reference group given their greater illness severity. These findings support the need for pregnancy-specific AKI frameworks to improve diagnosis and management.