Demographics and Outcomes Associated With End Stage Renal Disease After Pregnancy Related Acute Kidney Injury [3E

Abstract

INTRODUCTION: Pregnancy related acute kidney injury (AKI) remains an important cause of maternal and fetal morbidity and mortality, which can result in end-stage renal disease (ESRD) requiring life-long renal replacement. Little is known about the characteristics of those who develop ESRD after pregnancy related AKI. METHODS: The United States Renal Data System (USRDS) national registry between 1990 and 2015 was used to analyze the frequency of postpartum renal failure and associated risk factors. We used Cox proportional hazards models to evaluate risk factors for mortality and access to transplant among those with post-partum ESRD. RESULTS: There were 224 cases of ESRD due to post-partum renal failure vs 151,974 reproductive age women who developed ESRD secondary to other causes. Minorities were disproportionately affected: African-American women comprised 28.6% of those with post-partum renal failure but only represented 15.7% of births over the same time period. Similarly, Hispanic women represented 28.0% of those with post-partum renal failure but only 20% of live births. African-Americans with ESRD due to post-partum renal failure had a 2.15-fold higher hazard of mortality. Women with post-partum renal failure had better overall survival compared other causes of renal failure (HR=0.38, p<0.001). Despite this, women with post-partum renal failure had 0.45 lower hazards of receiving a kidney transplant, even after adjusting for demographic characteristics (P<.001). CONCLUSION: There are racial disparities in development of post-partum ESRD, with African-American and Hispanic women disproportionately affected. Women with post-partum ESRD are significantly less likely to receive a transplant despite having better overall survival.