Postpartum Acute Kidney Injury in Tertiary Care Center: Single-Center Experience from Central India

Abstract

Acute kidney injury (AKI) in postpartum is a rare, but deadly complication of pregnancy. It has great impact on maternal and fetal outcomes. The study aimed to study the incidence and etiological profile with outcomes of postpartum AKI patients and to see whether need for hemodialysis (HD) alters the outcome. This is a retrospective observation study done in a tertiary care center at the Department of Nephrology, Ramkrishnan Care Hospital, Raipur, Chhattisgarh, India. All postpartum women suffering from AKI between May 2011 and May 2017 were included in this study. Demographic, clinical, and laboratory data of the patients were included. Outcome variables including maternal and fetal mortality with renal outcome during discharge and follow-up for three months were noted. Patients were divided into two groups: Group 1 underwent HD and Group 2 was managed conservatively. Statistical analysis was done on the Statistical Package for the Social Sciences software version 17.0. Categorical data were expressed as ratio and proportions, while continuous data were expressed as mean plus standard deviation (SD). Quantitative data were analyzed by percentage, mean, SD, and t-test. Qualitative data were analyzed by Chi-square test. The incidence of postpartum AKI was 3.26% and the mean age of the study population was 27.3 ± 4.77 years. Multifactorial (53.27%) etiology was the most cause of postpartum AKI, and the second was puerperal sepsis (32.7%). Seventy-three (68.22%) patients had undergone HD. Four (4.47%) patients require lifelong HD. Renal biopsy was done in seven patients, three had cortical necrosis among fetal outcomes, total live births were 92 (85.98%), and 15 (14.01%) died in the neonatal period. There was no statistically significant difference between Group 1 and Group 2 in etiological profile (P >0.55), maternal mortality (P >0.66), and renal outcome (P >0.11). Postpartum AKI was associated with poor maternal outcome and renal recovery. Maternal mortality and renal recovery were not affected by need of dialysis in our patients. Proper antenatal care and peripartum monitoring with practicing aseptic precaution will definitely help in reduction of postpartum AKI and maternal mortality in our state.