Incidence and clinical outcomes of pregnancy-related acute kidney injury (PrAKI) in preeclampsia-complicated pregnancies in Saudi Arabia: a single-center experience.

Abstract

Background:  Hypertensive disorders of pregnancy are a leading cause of pregnancy-related acute kidney injury. Data on preeclampsia-complicated pregnancies in the Saudi population are limited.

Methods: This retrospective, single-center study analyzed preeclampsia-complicated pregnancies from January 2020 to December 2022, excluding those with chronic kidney disease. Baseline variables collected included age, ethnicity, body mass index, comorbidities, parity, antenatal care, use of in vitro fertilization, and multiple gestation pregnancies. Study outcomes included: 1. Pregnancy-related acute kidney injury incidence, defined as a serum creatinine > 77 µmol/L during pregnancy or an increase > 26.5 µmol/L within six weeks postpartum; 2. Comparison of fetomaternal outcomes between pregnancy-related acute kidney injury and non- pregnancy-related acute kidney injury groups; and 3. Pregnancy-related acute kidney injury risk factors.

Results: Pregnancy-related acute kidney injury occurred in 25 (19.4%) of the 129 preeclampsia-complicated pregnancies. It was significantly associated with adverse fetal outcomes, including higher rates of preterm birth (72% vs. 45.2%, P = 0.016), lower birth weight (1500 g vs. 2277.5 g, P = 0.002), intrauterine growth restriction (36% vs. 14.4%, P = 0.013), and intrauterine fetal death (28% vs. 8.7%, P = 0.008). However, no significant differences were observed in maternal outcomes. Independent predictors of pregnancy-related acute kidney injury included preexisting diabetes mellitus (Odds Ratio [OR] 3.534, P = 0.048), Hemolysis, Elevated Liver enzymes, and Low Platelet count. syndrome (OR 25.250, P = 0.004), and intrauterine fetal death (OR 4.105, P = 0.013). Antenatal care was associated with a reduced risk of pregnancy-related acute kidney injury (OR 0.196, P = 0.033).

Conclusions: pregnancy-related acute kidney injury is a common complication in preeclampsia-complicated pregnancies and is associated with poor fetal outcomes. Early identification and provision of antenatal care can significantly reduce the risk of pregnancy-related acute kidney injury.