King's Kidney Care, King's College Hospital NHS Trust, London, UK.
Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Nephrol Dial Transplant. 2021 May 27;36(6):1023-1030. doi: 10.1093/ndt/gfaa217.
Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored.
All pregnant or postpartum women with AKI e-alerts for AKI Stages 1-3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records.
288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls.
Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.
妊娠相关急性肾损伤（Pr-AKI）与母体发病率和死亡率密切相关。电子警报系统通常用于检测非妊娠患者的 AKI，但尚未探讨其在产科护理中的作用。
在一家三级中心，对超过 2 年时间内出现 AKI 1-3 期电子警报（KDIGO 标准）的所有妊娠或产后 AKI 孕妇或产妇进行了识别。每个病例选择 2 名按分娩日期匹配的女性作为对照。从电子病历中提取 AKI 分期、AKI 的识别、妊娠结局、肾功能恢复、AKI 病因和危险因素。
在 11922 名女性中，有 288 名（2.4%）出现 AKI 电子警报，其中只有 118 名（41%）被产科团队识别。常见的 Pr-AKI 病因包括感染（48%）、子痫前期（26%）和出血（25%），但 15%的女性病因不明。213 名（74%）女性肾功能恢复，但 47 名（17%）未进行重复检测，28 名（10%）未恢复功能。与对照组相比，妊娠高血压疾病和剖宫产与 Pr-AKI 发生率增加有关。
在大约 1/40 的妊娠中发现了 Pr-AKI 电子警报。然而，在许多情况下，Pr-AKI 的病因并未确定，电子警报可能是由于血清肌酐的妊娠变化引起的。可能需要针对妊娠的特定电子警报算法。然而，在 10%的 Pr-AKI 女性中，重复检测肾功能未恢复。需要更好地了解 Pr-AKI 对妊娠和肾脏结局的长期影响，以便为相关的 Pr-AKI 电子警报阈值提供信息。
