Epidemiology Of Acute Kidney Lnjury In Hospitalized Pregnant Women In China

Objective:To estimate the incidence of Acute Kidney Injury(AKI)in hospitalized pregnant women in China,using a standard definition(Kidney Disease Improving Global Outcomes criteria);to describe the clinical characteristics and risk profile for AKI during pregnancy and puerperium;and to evaluate the association between pregnant-related AKI and in-hospital outcomes.Design:EACH 2study(Epidemiology of AKI in Chinese Hospitalized patients2)is a multi-centered retrospective cohort study conducted in 25 regional medical centers from 15 provinces across China.The study cohort included 3,044,224patients admitted from January 1,2013 to December 31,2015.Subjects:We screened 10920 pregnant patients who had at least two Scr tests within any 7-day window during their first 30 days of hospitalization as the analysis set.We only included Scr tests that used an enzymatic assay and excluded patients with end-stage renal disease(ESRD),receiving maintenance dialysis or renal transplantation.We identified AKI events according to the serum creatinine criteria of KDIGO.A total of 795 AKI cases were identified among the 10920 pregnant women.Including 393 community-acquired AKI(CA-AKI)cases and 402 hospital-acquired AKI(HA-AKI)cases.Data source:We obtained patient-level data from the electronic hospitalization databases and laboratory databases from the participating centers.The hospitalization records consisted of patients’ age,sex,preexisting medical conditions,Pregnant complications,need for ICU,dialysis,in-hospital death and total hospitalization cost.The laboratory data included patients baseline serum creatinine and peack serum creatinine.The Medical Ethics Committee of Nanfang Hospital approved the study protocol.Results:Among 10920 pregnant women,AKI occurred in 7.3%(n-795)of the population in the analysis set,However,among the 795 AKI cases,only 4.0%(n=32)of AKI events,which were identified by Scr change,were diagnosed on the discharge record..The three clinical settings with the highest incidence AKI were acute fatty liver(AFLP)(66.1%),respiration failure(48.1%)/sepsis(28.9%)and shock(27.3%),The top three risk factors,ranked in order of decreasing population attributable fractions(PAF)were pregnancy induced hypertension(PIH)(21.12%),AFLP(13.49%)and chronic kidney disease(CKD)(6.19%).AKI was associated with longer length of stay in hospital(LOS)and higher cost during hospitalization.The mortality rate of AKI pregnant women in our cohort is 2.1%.COX survival analysis showed that AKI increased the risk of death in hospitalized women by 5.9 times compared with non-AKI pregnant women after adjusting for age,baseline creatinine levels,and complications.Compared with AKI-1 and AKI-2,AKI-3 phase increased the risk of death in hospitalized women by 11 times.Conclusion:Our cohort demonstrated that the incidence of pregnant-related AKI in China is 7.3%.PIH is the most common risk factors for developing AKI.The mortality of pregnant-related AKI in China is 2.1%.AKI in pregnancy is associated with higher maternal mortality rate,higher cost of hospitalization and longer length of stay,which should raise the concern among the public,the policy makers,and the health-care providers about early detection and appropriate treatment.