Incidence of pregnancy-related acute kidney injury in a low resource setting: A prospective study

Abstract

Background: Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and
burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access
to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of
PRAKI among women in the peripartum period in two government hospitals in Nigeria.
Methodology: This was a prospective study where serum creatinine was measured among pregnant women presenting
in labour at 0-hour, 6 hour, 12 hour, 24 hour, 48 hour and 7 days post-delivery. AKI was defined using the Kidney
Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI.
Results: The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of
AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis
(13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had
Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001),
excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002).
Conclusion: PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and
eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with
multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health
education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria.