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Risk factors and outcomes associated with pregnancy-related acute kidney injury in a high-risk cohort of women in Nigeria

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A Correction to this article was published on 27 December 2023

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Abstract

Introduction

Despite a decline in developed countries, pregnancy-related acute kidney injury (PRAKI) remains a significant contributor to maternal mortality and adverse fetal outcomes in resource-constrained settings. Little is known about the impact of pregnancy-related acute kidney injury in Nigeria. Therefore, this study aimed to assess the incidence and maternal-fetal outcomes associated with pregnancy-related acute kidney injury among a cohort of high-risk women in Nigeria.

Methods

This prospective multicenter study included women at high risk of acute kidney injury, who were more than 20 weeks pregnant or within 6 weeks postpartum and admitted to the Obstetrics and Gynecology units of two large public hospitals between September 1, 2019, and July 31, 2022. Acute kidney injury was defined and classified using the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results

A total of 433 women, with mean age (± standard deviation) of 28 ± 6 years, were included in the evaluation. Pregnancy-related acute kidney injury occurred in 113 women (26.1%; 95% confidence interval [CI]: 21.1%-30.2%). The leading cause was preeclampsia (n = 57; 50.1%); 19 women died (4.4%), with 17 deaths (15%) occurring in the PRAKI group. Increasing severity of pregnancy-related acute kidney injury was independently associated with maternal mortality: adjusted odds ratio (aOR) for KDIGO stage 2 = 4.40; 95% CI 0.66–29.34, p = 0.13, and KDIGO stage 3 aOR = 6.12; 95% CI 1.09–34.34, p = 0.04. The overall perinatal mortality was 15% (n = 65), with 28 deaths (24.8%) occurring in the PRAKI group. Pregnancy-related acute kidney injury was also associated with an increased risk of perinatal mortality, aOR = 2.23; 95 CI 1.17–4.23, p = 0.02.

Conclusions

The incidence of pregnancy-related acute kidney injury was high, and significantly associated with maternal and perinatal mortality. The leading causes were hypertensive disorders of pregnancy.

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References

  1. Lewington AJ, Cerda J, Mehta RL (2013) Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int 84(3):457–467

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jim B, Garovic VD (2017) Acute Kidney Injury in Pregnancy. Semin Nephrol 37(4):378–385

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kamal EM, Behery MM, Sayed GA, Abdulatif HK (2014) RIFLE classification and mortality in obstetric patients admitted to the intensive care unit with acute kidney injury: a 3-year prospective study. Reprod Sci (Thousand Oaks, Calif) 21(10):1281–1287

    Article  Google Scholar 

  4. Prakash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK, Srivastava PK, Raja R, Usha (2006) Acute renal failure in pregnancy in a developing country: twenty years of experience. Renal Fail 28(4):309–313

    Article  Google Scholar 

  5. Patel ML, Sachan R, Radheshyam SP (2013) Acute renal failure in pregnancy: Tertiary centre experience from north Indian population. Niger Med J J Niger Med Assoc 54(3):191–195

    Article  Google Scholar 

  6. Prakash J, Ganiger VC (2017) Acute Kidney Injury in Pregnancy-specific Disorders. Indian J Nephrol 27(4):258–270

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, Naicker S, Luyckx VA (2016) Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health 4(4):e242–e250

    Article  PubMed  Google Scholar 

  8. Adu D, Okyere P, Boima V, Matekole M, Osafo C (2016) Community-acquired acute kidney injury in adults in Africa. Clin Nephrol 86(13):48–52

    Article  PubMed  Google Scholar 

  9. Mehta RL, Cerda J, Burdmann EA, Tonelli M, Garcia-Garcia G, Jha V, Susantitaphong P, Rocco M, Vanholder R, Sever MS, Cruz D, Jaber B, Lameire NH, Lombardi R, Lewington A, Feehally J, Finkelstein F, Levin N, Pannu N, Thomas B, Aronoff-Spencer E, Remuzzi G (2015) International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet (London, England) 385(9987):2616–2643

    Article  PubMed  Google Scholar 

  10. Cooke WR, Hemmilä UK, Craik AL, Mandula CJ, Mvula P, Msusa A, Dreyer G, Evans R (2018) Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study. BMC Nephrol 19(1):25

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shalaby AS, Shemies RS (2022) Pregnancy-related acute kidney injury in the African continent: where do we stand? A systematic review. J Nephrol 35(9):2175–2189

    Article  PubMed  PubMed Central  Google Scholar 

  12. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L (2016) Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet (London, England) 387(10017):462–474

    Article  PubMed  Google Scholar 

  13. Meh C, Thind A, Ryan B, Terry A (2019) Levels and determinants of maternal mortality in northern and southern Nigeria. BMC Pregnancy Childb 19(1):417

    Article  Google Scholar 

  14. Kellum JA, Lameire N (2013) Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care (London, England) 17(1):204

    Article  Google Scholar 

  15. Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120(4):c179–c184

    Article  PubMed  Google Scholar 

  16. ACOG Practice Bulletin No (2019) 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol 133(1):1

    Google Scholar 

  17. Sentilhes L, Vayssière C, Deneux-Tharaux C, Aya AG, Bayoumeu F, Bonnet MP, Djoudi R, Dolley P, Dreyfus M, Ducroux-Schouwey C, Dupont C, François A, Gallot D, Haumonté JB, Huissoud C, Kayem G, Keita H, Langer B, Mignon A, Morel O, Parant O, Pelage JP, Phan E, Rossignol M, Tessier V, Mercier FJ, Goffinet F (2016) Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol 198:12–21

    Article  PubMed  Google Scholar 

  18. Trakarnvanich T, Ngamvichchukorn T, Susantitaphong P (2022) Incidence of acute kidney injury during pregnancy and its prognostic value for adverse clinical outcomes: A systematic review and meta-analysis. Medicine 101(30):e29563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Magee LA, Kramer MS, Liston RM, Joseph KS (2014) Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. BMJ (Clinical Research Ed) 349:g4731

    PubMed  Google Scholar 

  20. Bentata Y, Madani H, Berkhli H, Haddiya I, Saadi H, Mimouni A, Housni B (2015) Acute kidney injury according to KDIGO stages and maternal mortality in the intensive care unit. Intensive Care Med 41(3):555–556

    Article  CAS  PubMed  Google Scholar 

  21. Ferreira DP, Amorim FF, Matsuura AJ, de Sousa JL, Santana AR, de Souza JA, Imoto AM (2020) Pregnancy-related acute kidney injury: mortality and survival of patients treated at a maternal intensive care unit. J Nephrol 33(6):1361–1367

    Article  PubMed  Google Scholar 

  22. Prakash J, Ganiger VC, Prakash S, Iqbal M, Kar DP, Singh U, Verma A (2018) Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). J Nephrol 31(1):79–85

    Article  CAS  PubMed  Google Scholar 

  23. Prakash J, Prakash S, Ganiger VC (2019) Changing epidemiology of acute kidney injury in pregnancy: a journey of four decades from a developing country. Saudi J Kidney Dis Transplant 30(5):1118–1130

    Article  Google Scholar 

  24. Taber-Hight E, Shah S (2020) Acute kidney injury in pregnancy. Adv Chronic Kidney Dis 27(6):455–460

    Article  PubMed  PubMed Central  Google Scholar 

  25. Liu Y, Ma X, Zheng J, Liu X, Yan T (2017) Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 17(1):235

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kabbali N, Tachfouti N, Arrayhani M, Harandou M, Tagnaouti M, Bentata Y, Laouad I, Ramdani B, Bayahia R, Oualim Z, Houssaini TS (2015) Outcome assessment of pregnancy-related acute kidney injury in Morocco: A national prospective study. Saudi J Kidney Dis Transplant 26(3):619–624

    Article  Google Scholar 

  27. Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, Patel HV, Gumber VM (2014) Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India. Saudi J Kidney Dis Transplant 25(4):906–911

    Article  Google Scholar 

  28. Bouaziz M, Chaari A, Turki O, Dammak H, Chelly H, Ammar R, Nasri A, Ben Algia N, Bahloul M, Ben HC (2013) Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit. Ren Fail 35(9):1210–1215

    Article  CAS  PubMed  Google Scholar 

  29. Adimora GN, Odetunde IO (2007) Perinatal mortality in University of Nigeria Teaching Hospital (UNTH) Enugu at the end of the last millennium. Niger J Clin Pract 10(1):19–23

    CAS  PubMed  Google Scholar 

  30. Fawole AO, Shah A, Tongo O, Dara K, El-Ladan AM, Umezulike AC, Alu FE, Eniayewun AB, Fabanwo AO, Adewunmi AA, Adegbola O, Adebayo AA, Obaitan FO, Onala OE, Usman Y, Sullayman AO, Kailani S, Sa’id M (2011) Determinants of perinatal mortality in Nigeria. Int J Gynaecol Obstet 114(1):37–42

    Article  PubMed  Google Scholar 

  31. Tiruneh D, Assefa N, Mengiste B (2021) Perinatal mortality and its determinants in Sub Saharan African countries: systematic review and meta-analysis. Maternal Health Neonatol Perinatol 7(1):1

    Article  Google Scholar 

  32. Tukur J, Ahonsi B, Ishaku SM, Araoyinbo I, Okereke E, Babatunde AO (2013) Maternal and fetal outcomes after introduction of magnesium sulphate for treatment of preeclampsia and eclampsia in selected secondary facilities: a low-cost intervention. Matern Child Health J 17(7):1191–1198

    Article  PubMed  Google Scholar 

  33. Wang HY, Jiang Q, Shi H, Xu YQ, Shi AC, Sun YL, Li J, Ning Q, Shen GX (2016) Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis. Sci Rep 6:28826

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kennedy DA, Lupattelli A, Koren G, Nordeng H (2013) Herbal medicine use in pregnancy: results of a multinational study. BMC Complement Altern Med 13:355

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ahmed SM, Nordeng H, Sundby J, Aragaw YA, de Boer HJ (2018) The use of medicinal plants by pregnant women in Africa: a systematic review. J Ethnopharmacol 224:297–313

    Article  PubMed  Google Scholar 

  36. Viljoen E, Visser J, Koen N, Musekiwa A (2014) A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J 13:20

    Article  PubMed  PubMed Central  Google Scholar 

  37. Cuzzolin L, Francini-Pesenti F, Verlato G, Joppi M, Baldelli P, Benoni G (2010) Use of herbal products among 392 Italian pregnant women: focus on pregnancy outcome. Pharmacoepidemiol Drug Saf 19(11):1151–1158

    Article  PubMed  Google Scholar 

  38. Kurzhagen JT, Dellepiane S, Cantaluppi V, Rabb H (2020) AKI: an increasingly recognized risk factor for CKD development and progression. J Nephrol 33(6):1171–1187

    Article  CAS  PubMed  Google Scholar 

  39. Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, Collins AJ (2009) Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 20(1):223–228

    Article  PubMed  PubMed Central  Google Scholar 

  40. Gaber TZ, Shemies RS, Baiomy AA, Aladle DA, Mosbah A, Abdel-Hady ES, Sayed-Ahmed N, Sobh M (2021) Acute kidney injury during pregnancy and puerperium: an Egyptian hospital-based study. J Nephrol 34(5):1611–1619

    Article  PubMed  Google Scholar 

  41. Gopalakrishnan N, Dhanapriya J, Muthukumar P, Sakthirajan R, Dineshkumar T, Thirumurugan S, Balasubramaniyan T (2015) Acute kidney injury in pregnancy–a single center experience. Ren Fail 37(9):1476–1480

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the International Society of Nephrology for funding this research through the ISN clinical research program. AMN was partly supported by the Fogarty International Center and the National Institute of Alcohol Abuse and Alcoholism of the U.S. National Institutes of Health (D43TW011544). The content is solely the responsibility of the authors and does not necessarily represent the official position of the U.S. National Institutes of Health.

Funding

This research was funded by the International Society Nephrology through the ISN clinical research program.

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Authors and Affiliations

  1. Renal Unit, Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria

    Bala Waziri & Isah A. Umar

  2. Jummai Babangida Aliyu Maternal and Neonatal Hospital, Minna, Nigeria

    Aminu Magaji & Chijioke C. Umelo

  3. Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria

    Aisha M. Nalado

  4. Vanderbilt Institute for Global Health (VIGH), Vanderbilt University Medical Center (VUMC), Nashville, TN, USA

    C. William Wester & Muktar H. Aliyu

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  1. Bala Waziri
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Correspondence to Bala Waziri.

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The research protocol was approved by the Health Research and Ethics Committee of Ibrahim Badamasi Babangida Specialist Hospital, Nigeria.

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Waziri, B., Umar, I.A., Magaji, A. et al. Risk factors and outcomes associated with pregnancy-related acute kidney injury in a high-risk cohort of women in Nigeria. J Nephrol 37, 587–596 (2024). https://doi.org/10.1007/s40620-023-01822-6

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