Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020;51(3):216-226.
doi: 10.1159/000505894. Epub 2020 Feb 11.

Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization

Silvi Shah  1 , Karthikeyan Meganathan  2 , Annette L Christianson  2 , Kathleen Harrison  3 , Anthony C Leonard  4 , Charuhas V Thakar  3   5
Affiliations

Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization

Silvi Shah et al. Am J Nephrol. 2020.

Abstract

Background: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied.

Methods: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations.

Results: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95% CI 1.36-1.64) and 41-49 years (OR 2.12; 95% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95% CI 1.40-1.65) and Native Americans (OR 1.45; 95% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47-17.42) and CV events (OR 9.74; 95% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447).

Conclusion: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

Keywords: Acute kidney injury; Mortality; Pregnancy; Race/ethnicity.

PubMed Disclaimer

Conflict of interest statement

All the authors have no disclosures and competing interests. The results presented in this paper have not been published previously in whole or part, except in abstract format. The Nationwide Inpatient Sample has supplied the data reported here. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the U.S. government.

Figures

Fig. 1
Fig. 1
Rates of pregnancy-related AKI hospitalizations from 2006 to 2015 by (a) diabetes, (b) age, and (c) race/ethnicity. AKI, acute kidney injury.
Fig. 2
Fig. 2
Multivariable logistic regression model showing factors associated with inpatient mortality in pregnancy-related hospitalizations. AKI, acute kidney injury; CV, cardiovascular; AMI, acute myocardial infarction; CHF, congestive heart failure.
Fig. 3
Fig. 3
Rates of CV events during pregnancy-related hospitalizations by AKI. CV event defined by occurrence of AMI, CHF and/or stroke. CV, cardiovascular; AKI, acute kidney injury; AMI, acute myocardial infarction; CHF, congestive heart failure.
See this image and copyright information in PMC

References

    1. Heung M, Steffick DE, Zivin K, Gillespie BW, Banerjee T, Hsu CY, et al. Centers for Disease Control and Prevention CKD Surveillance Team. Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD An Analysis of Veterans Health Administration Data. Am J Kidney Dis. 2016 May;67((5)):742–52. - PMC - PubMed
    1. Pannu N, James M, Hemmelgarn B, Klarenbach S. Alberta Kidney Disease Network. Association between AKI, recovery of renal function and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2013 Feb;8((2)):194–202. - PMC - PubMed
    1. Siew ED, Davenport A. The growth of acute kidney injury a rising tide or just closer attention to detail? Kidney Int. 2015 Jan;87((1)):46–61. - PMC - PubMed
    1. Chawla LS, Amdur RL, Shaw AD, Faselis C, Palant CE, Kimmel PL. Association between AKI and long-term renal and cardiovascular outcomes in United States veterans. Clin J Am Soc Nephrol. 2014 Mar;9((3)):448–56. - PMC - PubMed
    1. Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011 Nov;6((11)):2567–72. - PMC - PubMed

Publication types

MeSH terms