Ethnic disparities in pregnancy-related acute kidney injury in a United Kingdom population.

Autor: Gama RM; King's Kidney Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. rouvick.gama@nhs.net., Bhaduri M; King's Fertility Unit, Fetal Medicine Research Institute, Windsor Walk, Denmark Hill, London, UK., Atkins W; King's Kidney Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK., Nwankiti MK; Department of Haematology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK., Hutchison G; Department of Obstetrics, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK., Thomas M; Department of Obstetrics, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK., Clark K; Department of Females and Children's Health, School of Life Course Sciences, King's College London, London, UK., Kelly CB; Centre of Public Health, Queen's University, Belfast, UK., Dalrymple KV; Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK., Vincent RP; Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.; Faculty of Life Sciences and Medicine, King's College London, London, UK., Kametas N; Harris Birthright Centre, Fetal Medicine Research Institute, Windsor Walk, Denmark Hill, London, UK., Bramham K; King's Kidney Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.; Department of Females and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2023 Apr; Vol. 36 (3), pp. 777-787. Date of Electronic Publication: 2023 Jan 13.
DOI: 10.1007/s40620-022-01516-5
Abstrakt: Background: The incidence of acute kidney injury in pregnancy (P-AKI) is rising and is associated with detrimental maternal and foetal outcomes. Ethnic disparities in pregnancy outcomes are well recognized, with females who identify as Black or Asian being more likely to die during pregnancy compared to females who identify as White ethnicity.
Methods: This study reports rates of P-AKI and associated risk factors in pregnant females of different ethnicities. All pregnancies were recorded between 2016 and 2020. AKI episodes were identified using electronic alerts. Ethnicity, AKI stage (1-3), obstetric outcomes and risk factors for P-AKI (chronic hypertension, pregnancy-induced hypertension and pre-eclampsia, and haemorrhage) were assessed.
Results: There were 649 P-AKI episodes from 16,943 deliveries (3.8%). Black females were more likely to have P-AKI (5.72%) compared to those who were White (3.12%), Asian (3.74%), mixed ethnicity (2.89%) and Other/Not Stated (3.10%). Black females, compared to White females, were at greater risk of developing P-AKI if they had haemorrhage requiring blood transfusion (OR 2.44, 95% CI 1.31,4.54; p < 0.001) or pregnancy-induced hypertension (OR 1.79, 95% CI 1.12, 2.86; p < 0.001). After adjusting for risk factors, Black females had increased risk of developing P-AKI (OR 1.52, 95% CI 1.22, 1.80; p < 0.001) compared to White females. Black females were at increased risk of developing P-AKI compared to White females. Mode of delivery, pregnancy-induced hypertension and haemorrhage are likely to have contributed. The increased risk persists despite accounting for these variables, suggesting that other factors such as socioeconomic disparities need to be considered.
Conclusions: The incidence of P-AKI is likely higher than previously stated in the literature. However, caution must be exercised, particularly with AKI stage 1, as the KDIGO system is not validated in pregnancy and gestational changes in renal physiology need to be considered. Pregnancy-specific AKI definitions are needed.
(© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.)
Databáze: MEDLINE
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