Hospitalizations for Pregnancy-related Kidney Injury Increasing

By Rob Goodier

November 15, 2019

NEW YORK (Reuters Health) - The rate of hospitalizations for pregnancy-related acute kidney injury (AKI) is increasing, and diabetes is adding to the risk, new research suggests.

The findings were presented November 9 at the annual meeting of the American Society of Nephrology in Washington, D.C.

"I encourage clinicians to routinely check renal panel during inpatient hospitalizations. AKI during pregnancy is associated with higher risks of mortality and cardiovascular events," lead author Dr. Silvi Shah of the University of Cincinnati, in Ohio, told Reuters Health by email.

"The present study suggests that implementation of specific interventions for the prevention, diagnosis, and management of AKI in pregnant women may reduce the burden of AKI during hospitalizations in the United States," Dr. Shah said.

Dr. Shah and colleagues analyzed data from more than 15.5 million hospitalizations of pregnant patients from the 2012-2015 Nationwide Inpatient Sample. Of these, 0.1% overall involved AKI, up from 0.09% in 2012 to 0.12% in 2015.

Women hospitalized with AKI had a mortality rate of 2.6%, compared to 0.01% of those without AKI. Adjusting for confounders, the former group had a 14-fold higher risk of in-hospital mortality and a 16-fold higher risk of cardiovascular events, Dr. Shah said.

The AKI-related hospitalization rate was ten times higher for patients with diabetes (1.1% vs. 0.1%), who made up 1.3% of the entire study group.

The rate of AKI-related hospitalizations also increased among patients with diabetes, from 0.9 percent in 2012 to 1.2 percent in 2015. On the other hand, diabetes did not appear to impact the mortality or discharge-to-home rates among pregnant women hospitalized with AKI.

Better detection and awareness among healthcare providers may explain the increasing rate of pregnancy-related hospitalizations linked to AKI, Dr. Shah said.

Other than diabetes, characteristics of patients more likely to be hospitalized with AKI during pregnancy include older age and black and Native American ethnicity, the study suggests.

"Acute kidney injury often occurs in a setting of other pregnancy-related complications such as preeclampsia, or infections, so there may be a lot going on," Dr. Pascale Lane, a pediatric nephrologist at the University of Oklahoma in Oklahoma City who was not involved in the research, said by phone.

"These women are often very sick, and they often have to deliver the fetus prematurely to try and save the mother," she told Reuters Health. "So, we've known that this was a bad thing in pregnancy, and this is confirming that it still is a bad thing to get kidney failure in pregnancy."


ASN Kidney Week 2019.