Division of Nephrology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Medicine (Baltimore). 2022 Jul 29;101(30):e29563. doi: 10.1097/MD.0000000000029563.
Acute kidney injury (AKI) that develops during pregnancy results from pregnancy-induced hypertension, hemorrhage, and sepsis, associated with morbidity and mortality in the fetus and mother. This meta-analysis was conducted to evaluate the incidence of pregnancy-related AKI (PR-AKI) and adverse clinical outcomes.
PubMed and Scopus were systematically searched for studies published between 1980 and 2021. We included cross-sectional, retrospective, and prospective cohort studies that reported the incidence of PR-AKI as well as adverse fetal and maternal clinical outcomes. A random-effects model meta-analysis was performed to generate summary estimates.
The meta-analysis included 31 studies (57,529,841 participants). The pooled incidence of PR-AKI was 2.0% (95% confidence interval [CI] 1.0-3.7). Only 49.3% of patients received antenatal care. The most common cause of PR-AKI was preeclampsia (36.6%, 95% CI 29.1-44.7). The proportion of patients requiring hemodialysis was 37.2% (95% CI 26.0-49.9). More than 70% of patients had complete recovery of renal function, while 8.5% (95% CI 4.7-14.8) remained dependent on dialysis. The pooled mortality rate of PR-AKI was 12.7% (95% CI 9.0-17.7). In addition, fetal outcomes were favorable, with an alive birth rate of 70.0% (95% CI 61.2-77.4). However, the rate of abortion and/or stillbirth was approximately 25.4% (95% CI 18.1-34.4), and the rate of intrauterine death was 18.6% (95% CI 12.8-26.2).
Although the incidence of PR-AKI is not high, this condition has a high impact on morbidity and mortality in both fetal and maternal outcomes. Early prevention and treatment from health care professionals are needed in PR-AKI, especially in the form of antenatal care and preeclampsia medication.
妊娠期间发生的急性肾损伤（AKI）源于妊娠相关性高血压、出血和感染，可导致胎儿和母亲出现发病率和死亡率。本荟萃分析旨在评估妊娠相关 AKI（PR-AKI）的发生率和不良临床结局。
系统检索了 1980 年至 2021 年发表的研究，包括横断面、回顾性和前瞻性队列研究，这些研究报告了 PR-AKI 的发生率以及胎儿和产妇的不良临床结局。采用随机效应模型进行荟萃分析，以生成汇总估计值。
荟萃分析纳入了 31 项研究（57529841 名参与者）。PR-AKI 的总体发生率为 2.0%（95%置信区间[CI]1.0-3.7）。仅有 49.3%的患者接受了产前保健。PR-AKI 最常见的病因是子痫前期（36.6%，95%CI 29.1-44.7）。需要血液透析的患者比例为 37.2%（95%CI 26.0-49.9）。超过 70%的患者肾功能完全恢复，而 8.5%（95%CI 4.7-14.8）仍依赖透析。PR-AKI 的总体死亡率为 12.7%（95%CI 9.0-17.7）。此外，胎儿结局良好，活产率为 70.0%（95%CI 61.2-77.4）。但是，流产和/或死胎率约为 25.4%（95%CI 18.1-34.4），宫内死亡发生率为 18.6%（95%CI 12.8-26.2）。
尽管 PR-AKI 的发生率不高，但这种情况对胎儿和产妇结局的发病率和死亡率都有很大影响。PR-AKI 患者需要医护人员进行早期预防和治疗，特别是产前保健和子痫前期药物治疗。
