Outcomes of pregnancy-related acute kidney injury: A retrospective study in the obstetric critical care unit at Kenyatta National Hospital 2020 to 2023.

Abstract

Pregnancy-related acute kidney injury (PrAKI) is defined as a rapid decline in kidney function in the pregnancy or puerperal period that can result in life-threatening organ dysfunction. This study aimed to investigate socio-demographic features of critically ill women with pregnancy-related acute kidney injury as well as their maternal and foetal outcomes. Retrospective analysis of data in patients with pregnancy-related kidney injury in the obstetric critical care unit at a public tertiary referral centre in Kenya between February 2020-2023. Of the 266 patient files reviewed, pregnancy-related acute kidney was found in 203 patients. The main predisposing factors for acute kidney injury were hypertensive disorders in pregnancy (64.1%), obstetric haemorrhage (38.4%) and sepsis (36.5%). According to KDIGO (Kidney Disease Improving Global Outcomes) criteria, 44 patients presented in stage 1 (21.7%), 58 in stage 2 and 101 in stage 3 (49.8%). Patients with KDIGO stage 3 had a higher risk of high SOFA (Sequential Organ Failure Assessment) score (p =< 0.001), longer ICU stay (p = 0.008) and longer duration on ventilation (p = 0.010). Seventy-six patients underwent dialysis (37.4%). Recovery of renal function was complete in 91 patients (44.8%), partial in 41 (20.2%) with dependence on dialysis seen in 23 (23.6%). Forty-eight patients died (23.6%). Risks associated with mortality were mechanical ventilation (p = 0.001) and inotropic support (p =< 0.001) with statistically significant higher mean SOFA scores in those who died versus those who survived (12.6 ± 3.8 p =< 0.001 vs 8.6 ± 3.2). The incidence of PrAKI is still underestimated in the Kenyan setting with the majority of the patients presenting with advanced renal injury. These patients are at higher risk of adverse maternal morbidity and mortality in the critical care setting.