Cardiovascular and Renal Outcomes Following Acute Kidney Injury in Pregnancy: A Systematic Review and Meta-Analysis

Acute kidney injury (AKI) in pregnancy is associated with adverse maternal and foetal outcomes. However, there is limited evidence regarding cardiac and renal outcomes associated with AKI in pregnancy.

To quantify and perform a meta-analysis of the risk of adverse cardiovascular and renal outcomes following AKI in pregnancy.

A systematic search of MEDLINE, Cochrane Library and EMBASE from inception until 23 January 2024.

Studies investigating adverse cardiovascular and renal outcomes in pregnant patients with AKI.

Two reviewers independently performed screening, data extraction and quality assessment. A random-effects model was used to estimate risk.

A total of 17 studies were included with 50 285 836 pregnant women, of which 36 806 women were affected by AKI. Our evidence synthesis showed that AKI in pregnancy is associated with a 52-fold increase in the risk of composite adverse renal outcomes (OR 52.37; 95% CI 4.67-587.63), a 23-fold increase in the risk of heart failure (OR 22.55; 95% CI 4.39-115.71) and stroke (OR 22.92; 95% CI 2.32-226.65), as well as a 9.3-fold and 3.9-fold increased risk of maternal mortality (OR 9.26; 95% CI 2.53-33.96) and intensive care unit admission (OR 3.86; 95% CI 1.93-7.71), respectively.

The study shows that AKI in pregnancy is associated with adverse cardiovascular and renal outcomes. Careful monitoring and follow-up of patients with AKI in pregnancy may enable earlier detection and management of some adverse cardiovascular and renal outcomes.