1012 Acute kidney injury in pregnancies complicated by preeclampsia with severe features

Abstract

Acute kidney injury (AKI) complicating pregnancy is used as a marker of severe maternal morbidity (SMM) and frequently associated with hypertensive disorders. Our aim was to examine AKI in pregnancies complicated by preeclampsia with severe features (SPE) using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. This was a retrospective cohort study of women with care established before 20 weeks with diagnosis of SPE and delivery > or = 34 weeks at an academic public hospital. To mitigate confounding of underlying renal dysfunction, women with chronic hypertension were excluded. KDIGO criteria for diagnosis of AKI were applied to stratify stages of renal disease at admission and during the delivery episode. Demographics and perinatal outcomes were compared using chi square with P<0.05 considered significant. From January 2015 through December 2019, 4028 women with SPE were delivered meeting inclusion criteria and 1096 (27%) of these met KDIGO criteria for AKI during their delivery episode. Of those with AKI, 690 (63%) had AKI at the time of admission and the remaining 406 (37%) developed AKI after admission. Of women with AKI, 1080 (98%) had stage I; 9 (0.82%) stage II; and 7 (0.63%) stage III renal disease stratified by KDIGO criteria. Demographic differences between those with and without AKI include younger age, race or ethnicity, and nulliparity (Table). Women with AKI had significantly higher rates of cesarean delivery, postpartum hemorrhage, and longer lengths of stay. More than a fourth of women with SPE delivered at > or = 34 weeks were found to have AKI by KDIGO criteria. The vast majority of AKI was stage I disease, and more than 60% were present on admission. AKI at time of delivery is associated with adverse outcomes. Future efforts defining SMM indicators could consider whether AKI is already present at the time of admission or develops intrapartum.