Pregnancy-Related Acute Kidney Injury and Socioeconomic Factors

Boston—In the United States, rates of pregnancy-related morbidity are increasing, and minority women are a higher risk than white women. Pregnancy-related acute kidney injury (Pr-AKI) has risen 300% from 1993 to 2014; however, there are few data available on racial trends in Pr-AKI. Kelly Beers, MD, and colleagues utilized a nationally representative dataset to examine trends in Pr-AKI by self-reported race. They reported results of the analysis during a poster session at the NKF 2019 Spring Clinical Meetings in a poster titled Racial Disparities in Pregnancy-Related Acute Kidney Injury.

Hospitalizations for pregnancy and diagnoses of AKI were identified using International Classification of Diseases codes. The researchers estimated trends in AKI and the impact of race on outcomes, then adjusted for socioeconomic and hospital-related factors.

From 2005 to 2014, there were 9,768,905 pregnancy hospitalizations; 7058 of those had Pr-AKI (0,.72 per 1000 hospitalizations). The patients with Pr-AKI were older, more likely to be black (Pr-AKI 29% vs non-AKI 12%; P<.001), and have an All Patient Refined-Diagnosis Related Group mortality score of 4 (Pr-AKI 33% vs non-AKI 0.1%).

There was an increase in hospitalization rate for Pr-AKI from 0.04% in 2005 to 0.12% in 2015. The increase was largest in blacks. There was an association between AKI and increased odds of preterm labor, miscarriage, mortality and discharge other than home. Proportions of all adverse outcomes were higher among black and Hispanic women hospitalized for Pr-AKI. This was attenuated following adjustment for socioeconomic factors; however, Hispanics women had higher odds of preterm labor, and both Hispanic and black women had higher odds of preeclampsia/eclampsia compared with white women.

The researchers said, “Pr-AKI is increasing significantly and associated with adverse outcomes in pregnancy, with a sharper rise in racial/ethnic minorities. Many of those differences are attenuated after adjustment for socioeconomic factors, although notable differences in preterm labor and preeclampsia remain. Our findings suggest that socioeconomic factors play a significant role in the increased risk of Pr-AKI among minority women.”

Source: Beers K, Dave M, Nadkarni G, Coca S, Chan L. Racial disparities in pregnancy-related acute kidney injury. Abstract of a poster presented at the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.