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Severe Pregnancy-Associated Acute Kidney Injury and Maternal Vulnerability
Hung-Wei Liao1, Valerie Luyckx2,3, Marlies Ostermann4
1Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei, Taiwan.
Summary
Severe pregnancy-associated acute kidney injury (PrAKI) incidence tripled, with increased maternal mortality during the COVID-19 pandemic. This highlights the need for early risk assessment and care for pregnant individuals with cardiometabolic conditions.
Area of Science:
- Nephrology
- Obstetrics & Gynecology
- Public Health
Background:
- Severe pregnancy-associated acute kidney injury (PrAKI) is a rare but critical obstetric complication.
- Limited contemporary data exist on PrAKI trends and the COVID-19 pandemic's impact in high-income nations.
- This study investigates temporal changes in PrAKI context and outcomes in the US.
Purpose of the Study:
- To examine temporal trends in severe PrAKI incidence, maternal mortality, and dialysis utilization in the US (2012-2022).
- To identify factors associated with severe PrAKI, including the influence of the COVID-19 pandemic.
Main Methods:
- Retrospective cohort study of 4,094,111 pregnancies using electronic health records.
- Severe PrAKI defined by dialysis initiation or eGFR < 15 mL/min/1.73 m².
- Logistic regression analyzed temporal trends and associated factors, including COVID-19 impact.
Main Results:
- Severe PrAKI incidence increased nearly threefold from 2012-2013 to 2020-2022 (COVID-19 era).
- Maternal mortality rose during the COVID-19 period, while dialysis rates remained stable.
- Older maternal age, cardiometabolic comorbidities (hypertension, obesity, diabetes), chronic kidney disease, and COVID-19 were associated with PrAKI.
Conclusions:
- Severe PrAKI is linked to acute systemic illness in women with underlying chronic cardiometabolic conditions.
- Rising mortality despite stable dialysis use necessitates earlier risk stratification and multidisciplinary care.
- Improved management strategies are crucial to reduce maternal mortality in severe PrAKI cases.
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