Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery

Rouvick M Gama; Katherine Clark; Mahua Bhaduri; Amanda Clery; Kelly Wright; Priscilla Smith; Hayley Martin; Royce P Vincent; Satish Jayawardene; Kate Bramham

doi:10.1093/ndt/gfaa217

Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery

Rouvick M Gama, Katherine Clark, Mahua Bhaduri, Amanda Clery, Kelly Wright, Priscilla Smith, Hayley Martin, Royce P Vincent, Satish Jayawardene, Kate Bramham

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored.

METHODS: All pregnant or postpartum women with AKI e-alerts for AKI Stages 1-3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records.

RESULTS: 288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls.

CONCLUSIONS: Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.

Original language	English
Pages (from-to)	1023-1030
Number of pages	8
Journal	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Volume	36
Issue number	6
DOIs	https://doi.org/10.1093/ndt/gfaa217
Publication status	Published - 27 May 2021

Keywords

Acute Kidney Injury/diagnosis
Cesarean Section
Creatinine
Female
Humans
Maternal Health Services
Pregnancy
Pregnancy Outcome
Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/ndt/gfaa217

Cite this

Gama, R. M., Clark, K., Bhaduri, M., Clery, A., Wright, K., Smith, P., Martin, H., Vincent, R. P., Jayawardene, S., & Bramham, K. (2021). Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 36(6), 1023-1030. https://doi.org/10.1093/ndt/gfaa217

@article{58612347a4644d84ac372da25904fb1c,

title = "Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery",

abstract = "BACKGROUND: Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored.METHODS: All pregnant or postpartum women with AKI e-alerts for AKI Stages 1-3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records.RESULTS: 288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls.CONCLUSIONS: Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.",

keywords = "Acute Kidney Injury/diagnosis, Cesarean Section, Creatinine, Female, Humans, Maternal Health Services, Pregnancy, Pregnancy Outcome, Risk Factors",

author = "Gama, {Rouvick M} and Katherine Clark and Mahua Bhaduri and Amanda Clery and Kelly Wright and Priscilla Smith and Hayley Martin and Vincent, {Royce P} and Satish Jayawardene and Kate Bramham",

year = "2021",

month = may,

day = "27",

doi = "10.1093/ndt/gfaa217",

language = "English",

volume = "36",

pages = "1023--1030",

journal = "Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "6",

}

Gama, RM, Clark, K, Bhaduri, M, Clery, A, Wright, K, Smith, P, Martin, H, Vincent, RP, Jayawardene, S & Bramham, K 2021, 'Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery', Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, vol. 36, no. 6, pp. 1023-1030. https://doi.org/10.1093/ndt/gfaa217

Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery. / Gama, Rouvick M; Clark, Katherine; Bhaduri, Mahua et al.
In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Vol. 36, No. 6, 27.05.2021, p. 1023-1030.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Acute kidney injury e-alerts in pregnancy

T2 - rates, recognition and recovery

AU - Gama, Rouvick M

AU - Clark, Katherine

AU - Bhaduri, Mahua

AU - Clery, Amanda

AU - Wright, Kelly

AU - Smith, Priscilla

AU - Martin, Hayley

AU - Vincent, Royce P

AU - Jayawardene, Satish

AU - Bramham, Kate

PY - 2021/5/27

Y1 - 2021/5/27

N2 - BACKGROUND: Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored.METHODS: All pregnant or postpartum women with AKI e-alerts for AKI Stages 1-3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records.RESULTS: 288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls.CONCLUSIONS: Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.

AB - BACKGROUND: Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored.METHODS: All pregnant or postpartum women with AKI e-alerts for AKI Stages 1-3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records.RESULTS: 288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls.CONCLUSIONS: Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.

KW - Acute Kidney Injury/diagnosis

KW - Cesarean Section

KW - Creatinine

KW - Female

KW - Humans

KW - Maternal Health Services

KW - Pregnancy

KW - Pregnancy Outcome

KW - Risk Factors

U2 - 10.1093/ndt/gfaa217

DO - 10.1093/ndt/gfaa217

M3 - Article

C2 - 33089321

SN - 0931-0509

VL - 36

SP - 1023

EP - 1030

JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

IS - 6

ER -

Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this