背景:在低资源环境中,妊娠相关的肾损伤导致急性肾损伤的高负担,并导致孕产妇和围产期的发病率和死亡率。很少有研究在资源有限的国家检查急性肾损伤的影响。对埃塞俄比亚妊娠特异性疾病的研究非常有限。本研究旨在确定妊娠相关急性肾损伤的特点,结果和相关因素。
方法:在提格雷的艾德综合专科医院进行了一项回顾性研究,以评估妊娠相关急性肾损伤的临床特征和母胎结局。埃塞俄比亚,从2017年1月1日至2021年12月31日。使用描述性统计学方法分析产妇和胎儿的结局。多变量逻辑回归用于确定因变量和自变量之间的关联。
结果:在2017年1月1日至2021年12月31日期间在艾德综合专科医院分娩的27,350名母亲中,共有187名妇女发生了与妊娠相关的急性肾损伤,患病率为每100,000名新生儿68名。先兆子痫,在本研究中,脓毒症和因脱水和出血引起的肾前原因是妊娠相关急性肾损伤的最常见原因.8.6%(n=16)的患者需要血液透析。在187例妊娠相关急性肾损伤中,143(76.5%)完全恢复,30(16%)部分恢复。死亡率为7.5%。先前存在的慢性肾脏疾病(AOR=30.13;95%CI:2.92,310.84),使用血管活性药物(AOR=5.77;95%CI:1.47,22.67),单位肌酐升高(AOR=1.65;95%CI:1.11,2.45)和与急性肾损伤相关的并发症(AOR=5.26;95%CI:1.73,16.00)是复合终点(部分肾恢复和死亡)的决定因素.
结论:本研究强调资源有限环境下的急性肾损伤是孕产妇和胎儿发病和死亡的重要原因。绝大多数妊娠相关急性肾损伤患者从肾损伤中完全恢复。妊娠相关急性肾损伤的主要原因为子痫前期,脓毒症和肾前出血和脱水相关。先前存在的肾脏疾病,使用血管升压药,单位肌酐的增加和与急性肾损伤相关的并发症是伴随胎儿死亡的决定因素.对于妊娠相关的急性肾损伤,需要在产前护理和及时治疗期间采取适当的预防策略。
BACKGROUND: Pregnancy-related kidney injury contributes to a high burden of acute kidney injury in low-resource settings and causes maternal and perinatal morbidity and mortality. Few studies have examined the impact of acute kidney injury in resource-limited countries, with very limited research on pregnancy-specific disorders in Ethiopia. This study aimed to determine the characteristics of pregnancy-related acute kidney injury, outcomes and associated factors.
METHODS: A retrospective study was conducted to evaluate the clinical profile and maternal-fetal outcome of pregnancy-related acute kidney injury at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Maternal and fetal outcomes were analyzed using descriptive statistics. Multivariate logistic regression was used to determine the association between the dependent and independent variables.
RESULTS: Of 27,350 mothers who delivered at Ayder Comprehensive Specialized Hospital between January 1, 2017, and December 31, 2021, a total of 187 women developed pregnancy-related acute kidney injury, a prevalence rate of 68 per 100,000 births. Preeclampsia, sepsis and pre-renal causes due to dehydration and hemorrhage were the most common causes of pregnancy-related acute kidney injury in this study. Hemodialysis was needed in 8.6% (n = 16) of patients. Of the 187 pregnancy-related acute kidney injuries, 143 (76.5%) recovered completely and 30 (16%) partially. The mortality rate was 7.5%. Preexisting chronic kidney disease (AOR = 30.13; 95% CI: 2.92, 310.84), use of vasoactive agents (AOR = 5.77; 95% CI: 1.47, 22.67), increase in creatinine per unit (AOR = 1.65; 95% CI: 1.11, 2.45) and complications related to acute kidney injury (AOR = 5.26; 95% CI: 1.73, 16.00) were determinants of the composite endpoints (partial renal recovery and death).
CONCLUSIONS: This study emphasizes acute kidney injury in resource-limited settings is a significant cause of maternal and fetal morbidity and mortality. The vast majority of patients with pregnancy-related acute kidney injury recovered completely from kidney injury. The main causes of pregnancy-related acute kidney injury were preeclampsia, sepsis and pre-renal associated with hemorrhage and dehydration. Preexisting renal disease, use of vasopressors, increase in creatinine per unit and complications associated with acute kidney injury were determining factors for concomitant fetomaternal mortality. Appropriate preventive strategies during prenatal care and prompt treatment are needed for pregnancy-related acute kidney injury.