Prevalence, Risk Factors and Short-term Outcomes of Acute Kidney Injury in Women with Obstetric Complications in Dar es Salaam, Tanzania

Abstract

Abstract Introduction In keeping abreast with the International Society of Nephrology “0by25” initiative that aims at achieving zero preventable deaths from Acute Kidney Injury (AKI) by the year 2025, we investigated on Pregnancy-Related Acute Kidney Injury (PRAKI), a potentially preventable cause of AKI but still commonly reported in developing countries as a significant contributor to both maternal and fetal morbidity and mortality. In this study, we report on the prevalence, risk factors and outcomes of PRAKI among pregnant women with obstetric complications at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Methodology This was a hospital-based descriptive cross-sectional study involving women with obstetric complications in late pregnancy at MNH, Dar es Salaam, Tanzania from August 2015 to February 2016. Acute Kidney Injury Network (AKIN) criterion was used to define acute kidney injury (AKI). Data analysis was done using the Statistical Package of Social Sciences (SPSS) version 23. Results During the study period a total of 5448 deliveries occurred at MNH amongst whom 1150 (21.1%) women had obstetric complications. Overall, AKI occurred in 99(8.6%) and was stage-wise categorized into AKIN Stage I in 55/99(55.5%), Stage II in 8/99(8.1%), and Stage III in 36/99 (36.4%). Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome and severe pre-eclampsia were the most frequent obstetric complications among patients with PRAKI. PRAKI was associated with advanced maternal age, being HIV positive, having history of hypertension and/or having elevated blood pressure, albuminuria and having anemia detected during antenatal clinic (ANC) visits. Among patients who developed PRAKI; hemodialysis therapy was offered to 6/99(6.1%) patients who after several rounds of therapy were able to recover their renal function; 66/99 (66.7%) had partial recovery of renal function whereas 27/99 (27.3%) had complete spontaneous recovery of their renal function without need of hemodialysis therapy. On considering fetal outcome; PRAKI was associated with delivering a stillbirth baby. Conclusion In this novel study on PRAKI in Tanzania, we found that PRAKI is common among women with obstetric complications and strong associated with advanced maternal age, being HIV positive, having history of hypertension, albuminuria or anemia detected during antenatal clinic visits. Early recognition and treatment of PRAKI may help prevent associated poor maternal and fetal outcomes and in a broader sense, it a significant step forward into achieving the ISN “0by25” global initiative in Tanzania