Characteristics of AKI in pregnancy and identification of factors associated with poor outcomes

Abstract

Background: Acute Kidney Injury (AKI) in pregnancy is a significant medical concern, particularly in low- and middle-income countries (LMICs), where access to healthcare is limited. AKI during pregnancy leads to severe maternal and fetal complications, including increased morbidity and mortality. The condition has multifactorial causes that vary by trimester, with hypertensive disorders, sepsis, and hemorrhage being primary contributors. Despite advances in nephrology and maternal-fetal medicine, gaps remain in the early detection and optimal management of pregnancy-related AKI.

Objective: This study aims to characterize the clinical presentation of AKI in pregnancy and identify factors associated with poor maternal and fetal outcomes in a tertiary hospital in Dhaka, Bangladesh.

Methodology: A retrospective facility-based study was conducted at a tertiary care hospital in Dhaka, Bangladesh, from June 2023 to June 2024. Medical records of 187 women diagnosed with pregnancy-related AKI were reviewed. Patients were identified from maternity ward logbooks, emergency department records, and ICU admission registers. AKI was diagnosed based on serum creatinine levels (≥1.2 mg/dL or an increase of ≥0.3 mg/dL within 48 hours), reduced urine output, or dialysis requirement. Data were collected using a structured questionnaire and analyzed using Stata 16. Statistical analyses included chi-square tests, Fisher’s exact tests, and multivariate logistic regression.

Results: Antenatal care was significantly lower in patients experiencing adverse outcomes (59.1% vs. 77.6%, p = 0.015). Vaginal delivery was more common in the composite endpoint group (70.5% vs. 48.2%, p = 0.022). Hypertensive disorders, particularly preeclampsia, were more frequent in the non-composite endpoint group (79.0% vs. 63.6%, p = 0.038). Sepsis (59.1% vs. 46.1%) and pre-renal AKI (50.0% vs. 37.8%) were more prevalent in the composite endpoint group. Anemia (72.7% vs. 46.1%, p = 0.008) and elevated serum creatinine (≥3.0 mg/dL: 40.9% vs. 6.3%, p < 0.001) were significantly associated with worse outcomes. Patients with preexisting chronic kidney disease (CKD) had a significantly higher risk of adverse outcomes (22.7% vs. 0.7%, p < 0.001).

Conclusion: Pregnancy-related AKI remains a critical challenge in Bangladesh, with inadequate antenatal care, hypertensive disorders, and sepsis contributing to poor maternal outcomes. Early detection, timely intervention, and a multidisciplinary approach involving nephrologists, obstetricians, and critical care specialists are essential to improving prognosis. Strengthening maternal healthcare infrastructure and increasing access to specialized care are crucial in reducing the burden of AKI in pregnancy.