+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study



Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study



Bmc Nephrology 19(1): 25



Obstetric-related acute kidney injury (AKI) is thought to be a key contributor to the overall burden of AKI in low resource settings, causing significant and preventable morbidity and mortality. However, epidemiological data to corroborate these hypotheses is sparse. This prospective observational study aims to determine the incidence, aetiology and maternal-fetal outcomes of obstetric-related AKI in Malawi. Women greater than 20 weeks gestation or less than 6 weeks postpartum admitted to obstetric wards at a tertiary hospital in Blantyre, Malawi, and at high-risk of AKI were recruited between 21st September and 11th December 2015. All participants had serum creatinine tested at enrolment; those with creatinine above normal range (> 82 μmol/L) underwent serial measurement, investigations to determine cause of kidney injury, and were managed by obstetric and nephrology teams. AKI was diagnosed and staged by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Primary outcomes were the incidence proportion and aetiology of AKI. Secondary outcomes were in-hospital maternal mortality, need for dialysis, renal recovery and length of stay; in-hospital perinatal mortality, gestational age at delivery, birthweight and Apgar score. 354 patients were identified at risk of AKI from the approximate 2300 deliveries that occurred during the study period. Three hundred twenty-two were enrolled and 26 (8.1%) had AKI (median age 27 years; HIV 3.9%). The most common primary causes of AKI were preeclampsia/eclampsia (n = 19, 73.1%), antepartum haemorrhage (n = 3, 11.5%), and sepsis (n = 3, 11.5%). There was an association between preeclampsia spectrum and AKI (12.2% AKI incidence in preeclampsia spectrum vs. 4.3% in other patients, p = 0.015). No women with AKI died or required dialysis and complete renal recovery occurred in 22 (84.6%) cases. The perinatal mortality rate across all high-risk admissions was 13.8%. AKI did not impact on maternal or fetal outcomes. The incidence of AKI in high-risk obstetric admissions in Malawi is 8.1% and preeclampsia was the commonest cause. With tertiary nephrology and obstetric care the majority of AKI resolved with no effect on maternal-fetal outcomes. Maternal-fetal outcomes in Sub-Saharan Africa may be improved with earlier detection of hypertensive disease in pregnancy.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 065230334

Download citation: RISBibTeXText

PMID: 29394890

DOI: 10.1186/s12882-018-0824-6


Related references

Characteristics and Outcome of Obstetric Acute Kidney Injury in Pakistan: A Single-center Prospective Observational Study. Cureus 10(9): E3362, 2018

Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi. Bmc Nephrology 18(1): 21, 2017

Incidences and clinical outcomes of acute kidney injury in ICU: a prospective observational study in Sri Lanka. Bmc Research Notes 7: 305, 2014

The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study. Bmc Nephrology 15: 169, 2014

Impact of Compliance with a Care Bundle on Acute Kidney Injury Outcomes: A Prospective Observational Study. Plos one 10(7): E0132279, 2015

Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet. Child and Adolescent Health 1(3): 184-194, 2017

One- and three-year outcomes in patients treated with intermittent hemodialysis for acute kidney injury: prospective observational multicenter post-hoc FINNAKI study. Acta Anaesthesiologica Scandinavica 62(10): 1452-1459, 2018

Acute kidney injury-incidence, prognostic factors, and outcome of patients in an Intensive Care Unit in a tertiary center: A prospective observational study. Indian Journal of Critical Care Medicine 20(6): 332-336, 2016

Incidence, Etiology, and Outcomes of Community-Acquired Acute Kidney Injury in Pediatric Admissions in Malawi. Peritoneal Dialysis International 38(6): 405-412, 2018

Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Critical Care Medicine 39(6): 1493-1499, 2011

Risk factors for community-acquired acute kidney injury in patients with and without chronic kidney injury and impact of its initial management on prognosis: a prospective observational study. Bmc Nephrology 18(1): 380, 2017

A prospective national study of acute renal failure treated with RRT: incidence, aetiology and outcomes. Nephrology Dialysis Transplantation 22(9): 2513-2519, 2007

Does sodium bicarbonate infusion really have no effect on the incidence of acute kidney injury after cardiac surgery? A prospective observational trial. Critical Care 19: 183, 2015

Prediction of chronic kidney disease after acute kidney injury in ICU patients: study protocol for the PREDICT multicenter prospective observational study. Annals of Intensive Care 8(1): 77, 2018

Hypopituitarism in patients with vasculotoxic snake bite envenomation related acute kidney injury: a prospective study on the prevalence and outcomes of this complication. Pituitary 17(2): 125-131, 2014