Pregnancy-related acute kidney injury requiring dialysis as an indicator of severe adverse maternal morbidity at a tertiary center in Southwest Nigeria

Abstract

ObjectiveDespite being a Critical Intervention in the WHO Near-miss concept, the indications and clinical outcomes of patients with Pregnancy-Related Acute Kidney Injury (PRAKI) requiring dialysis at the Obafemi Awolowo University Teaching Hospitals Complex, Nigeria remain unknown. This retrospective review was conducted to facilitate counselling, prognostication and introduction of preventative measures by providing contemporary data on the aetiology and clinical outcomes of women with PRAKI. Study designA retrospective review. The indications for dialysis and feto-maternal outcomes of women with PRAKI requiring dialysis between January 2007 and December 2016 were reviewed. Analysis was performed with IBM SPSS 21.0. ResultsThere were 43 patients with PRAKI that required dialysis and 11,242 live births, with Maternal Near Miss Ratio (MNMR) of 3.8/1000 live births. Preeclampsia/ecclampsia (40%), Sepsis (37.5%) and Haemorrhage (20%) were the leading aetiologies of kidney injury, while oligo-anuria (100%) was the commonest clinical presentation. Majority (78%) of them had ≤four dialysis sessions before recovery of renal function. The mean (±SD) gestational age and birth weight at delivery were 36 (±3.1) weeks and 2.9 (±0.6)kg, while the Maternal Mortality Index and Perinatal mortality rates were 18% and 34% respectively. Delayed referral, and lower number of dialysis sessions were the significant predictors of mortality, while four women discontinued care due to cost. ConclusionThe high rate of Pregnancy-related acute kidney injury requiring dialysis, with its attendant morbidity and mortality are largely preventable. The prognosis is however good with standardised care. Functional emergency obstetric services, and a review of the Nigerian healthcare financing system are advocated.