Acute Kidney Injury: Magnitude and Predictors of Maternal Outcomes among Pre-Eclamptic and Eclamptic Women in Mwanza, Tanzania

Abstract

Background: Acute kidney injury (AKI) that occurs during pregnancy or in the post-partum period is a serious obstetric complication with a significant risk of feto-maternal morbidity and mortality. Although globally there has been an overall decrease in the burden of pregnancy-related (PRAKI) AKI, recent studies show the increasing occurrence of this disease in Low-middle income countries (LMICs).
This study was conducted to determine the magnitude and predictors of maternal outcomes of pre-eclamptic and eclamptic-related acute kidney injury at Bugando Medical Centre (BMC) and Sengerema Designated District Hospital (SDDH) Mwanza, Tanzania.
Methods: A cohort study was conducted involving patients diagnosed with Preeclampsia-Eclampsia (PE-E) who were admitted at BMC and SDDH from November 2021 to June 2022. Data were collected through convenience sampling using a structured questionnaire. Statistical data analysis was performed using STATA version 15. A chi-square test was performed to test for significant associations between the predictor and outcome variables. A significant association was defined as a p-value of less than .05. Variables showing significant associations in the chi-square analysis were further analysed using multivariate logistic regression to evaluate the strength of the associations.
Results: The study enrolled a total of 258 women with PE-E. The magnitude of AKI was found to be 141(54.7%,) out of 258 participants, of which Kidney Disease Improving Outcomes (KDIGO) stage 1 accounted for 103 (73%) stage 2, 20 (14.2%) and stage 3, were 18 (12.8%). Of these, 141 participants with AKI, 101 (71.6%) resolved within 7 days of delivery, 12 (8.5%) persisted beyond 7 days after delivery, and 28 (19.8%) worsened. Serum creatinine stages 2 and 3 at admission, HIV positive status, and informal education status were highly associated with persistent/worsening AKI stage.
Conclusion: The magnitude of acute kidney injury was found to be high (54.7%) among pre-eclamptic and eclamptic patients in BMC and SDDH. AKI stages 2 and 3, HIV positive status and informal education level were associated with poor maternal outcomes mainly persistent AKI and worsening AKI.