Characteristics and outcome of postpartum acute kidney injury requiring dialysis: A single-center experience from North India

Abstract

Postpartum acute kidney injury (AKI) is one of the serious complications of pregnancy and is associated with high mortality and morbidity. We conducted this study to determine the characteristics and outcome of the most severe form of postpartum AKI requiring dialysis. This prospective, observational study was conducted in Sawai Man Singh Medical College, Jaipur. All postpartum female suffering from AKI requiring dialysis between July 2014 and December 2016 were included in the study. Demographic, clinical and laboratory data of the patients were recorded. Outcome variables included survival at hospital discharge and estimated glomerular filtration rate (eGFR) at three months of follow-up. Sixty (88.2%) out of 68 women admitted with postpartum AKI required dialysis. The mean age was 26.5 ± 4.3 years and the majority (80%) had institutional delivery. The mean sequential organ failure assessment (SOFA) score was 8.0 ± 2.9. Puerperal sepsis (n = 37, 61.6%), preeclampsia (n = 21, 35%), and antepartum hemorrhage (n = 14, 23.3%) were the most common obstetric complication associated with postpartum AKI. Maternal mortality was 28.3%. Higher SOFA score (P = 0.015, odds ratio [OR]: 1.99, confidence interval [CI]: 1.14-3.45) and diagnosis of sepsis (P = 0.048, OR: 26.3, CI: 1.03-678.3) were the independent predictors of mortality. Out of 37 patients who were followed up at three months, 51.3% had eGFR <60 mL/min/1.73 m2. Duration of anuria (in days) was the only independent predictor of (eGFR <60 mL/min/1.73 m2 at three months of follow-up (P = 0.029, OR: 1.2, CI: 1.02-1.46). Postpartum AKI requiring dialysis was associated with high mortality. More than half of the survivors had eGFR <60 mL/min/1.73 m2 on follow-up highlighting the need of appropriate follow-up.