Pregnancy-Associated Acute Kidney Injury in Low-Resource Settings: Progress Over the Last Decade

Abstract

Despite immense global effort, the maternal mortality rate in low-resource settings remains unacceptably high. Globally, this reflects the grave inequalities in access to health and reproductive services. Pregnancy-associated acute kidney injury (PRAKI) is an independent risk factor for mortality. The reported incidence of PRAKI in low- and middle-income countries is higher than that of high-income countries (4%-26% versus 1%-2.8%, respectively). Hypertensive disorders are now the leading cause of PRAKI in many regions, followed by hemorrhage and sepsis. PRAKI in low-resource settings carries a high mortality for both mother and child. Outcome studies suggest that PRAKI is associated with residual kidney dysfunction and may lead to dialysis dependence. This can be a death sentence in many regions with limited kidney replacement therapy. This review will summarize data on PRAKI on the African, Latin American, and Asian continents over the past decade. It will include the progress in published data, mortality, and treatment interventions and provide recommendations for the next decade.

Keywords: Pregnancy; acute kidney injury; hypertension in pregnancy; low- and middle-income countries; neonatal outcomes; resource challenges.

Figure 1.

Maternal mortality per region. (A) African region, (B) India, and (C) Pakistan between 2000 and 2017.

Figure 2.

Percentage decline in maternal mortality per country in Africa, Latin America, and Southern Asia between 2000 and 2017.

Figure 3.

A global perspective of births attended by skilled personnel. Reprinted with permission.