Maternal Mortality due to Pregnancy-Related Acute Kidney Injury (PRAKI); A Study of the Epidemiological Factors and Possible Solutions

This prospective observational study aimed to explore the epidemiology, causes, and outcomes of Pregnancy-Related Acute Kidney Injury (PRAKI) in a tertiary care center in North India and identify risk factors for mortality.

We enrolled adult obstetric patients with PRAKI according to Kidney disease improving global outcomes criteria between February 2021 and April 2022. Data on demographic characteristics, clinical features, causes of PRAKI, and outcomes were collected. Univariate and multivariate analyses were conducted to identify factors associated with mortality. PRAKI prevention bundles for patients and obstetricians were proposed on the basis of key findings of the study.

Of the 89 patients included, pre-eclampsia/eclampsia/HELLP syndrome, hemorrhage, and sepsis were the primary causes of PRAKI. Maternal mortality was alarmingly high at 24.7%. Factors independently associated with mortality were the need for vasopressor support and renal replacement therapy.

This study highlights the urgent need for preventive and therapeutic interventions to reduce maternal mortality related to PRAKI. On the basis of the key findings, PRAKI prevention bundles were proposed. The PRAKI prevention (patient) bundle included regular BP measurement during ANC visits, healthcare check-up if there is fever or drop in urine during pregnancy or immediate postpartum. The PRAKI prevention (obstetrician) bundle included regular BP measurement, urine culture, avoidance of nephrotoxic agents and hourly urine output monitoring during delivery and immediate postpartum. Implementing preventive measures, enhancing obstetric intensive care units, and improving antenatal care compliance may help mitigate the devastating impact of PRAKI.