Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Iran J Kidney Dis. 2024 Aug 20;18(4):195-203.
Despite the significant decline in the incidence of pregnancy-related acute kidney injury (AKI) in recent decades due to advancements in medicine and increased awareness of this disease, it remains an important risk factor for maternal morbidity and mortality. However, as fertilization techniques allow women of advanced age to become pregnant, the incidence of pregnancy-related AKI has increased. Consequently, early identification of and intervention for pregnancy-related AKI are particularly important.
This was a retrospective clinical analysis. Data were collected from pregnant patients who were treated in the ICU of Shengjing Hospital of China Medical University from January 2014 to June 2020; The patients were divided into two groups based on their kidney function status: AKI and non-AKI. Additionally, they were further categorized into recovered and non-recovered groups based on their prognosis. The Wilcoxon rank sum test and the chi-square test were used for multigroup comparisons, while logistic regression analysis was used for the analysis of risk factors. P < .05 was considered to indicate a statistically significant difference in all correlation analyses.
Among 874 pregnant women in this study, 136 had AKI (15.56%), while 36 developed chronic renal insufficiency (26.47%). Statistically significant associations were shown for shock (P = .002), sepsis (P < .001), coagulopathies (P = .001), liver insufficiency (P < .001), postpartum hemorrhage (P = .016), intrauterine fetal death (P = .042) and mechanical ventilation (P = .006) between the AKI-group and the non-AKI group. The development of AKI based on an elevated baseline creatinine level was significantly related to the outcome of renal function (P < .001), while a significant difference was shown in the use of continuous renal replacement therapy (CRRT) between the recovery group and the non-recovery group (P = .023).
We identified the relevant risk factors leading to pregnancy-related AKI and affecting the patients' prognosis. Shock, sepsis, coagulation disorders, liver insufficiency, postpartum hemorrhage, intrauterine fetal death and mechanical ventilation are independent risk factors for pregnancy-related AKI, while an elevated baseline creatine level is a key factor for poor prognosis. Meanwhile, early CRRT can effectively reverse renal outcomes.
尽管由于医学的进步和对这种疾病认识的提高，近几十年来与妊娠相关的急性肾损伤（AKI）的发病率显著下降，但它仍然是产妇发病率和死亡率的一个重要危险因素。然而，随着受精技术的发展，使高龄妇女能够怀孕，与妊娠相关的 AKI 的发病率有所增加。因此，早期识别和干预与妊娠相关的 AKI 尤为重要。
这是一项回顾性临床分析。研究数据来自于 2014 年 1 月至 2020 年 6 月在中国医科大学盛京医院 ICU 治疗的孕妇患者；根据肾功能状况将患者分为 AKI 组和非 AKI 组；此外，根据预后将患者进一步分为恢复组和未恢复组。采用 Wilcoxon 秩和检验和卡方检验进行多组比较，采用逻辑回归分析进行危险因素分析。P<.05 被认为在所有相关性分析中具有统计学意义。
在这项研究的 874 名孕妇中，有 136 名患有 AKI（15.56%），36 名患有慢性肾功能不全（26.47%）。AKI 组与非 AKI 组之间的休克（P=.002）、败血症（P<.001）、凝血功能障碍（P=.001）、肝功能不全（P<.001）、产后出血（P=.016）、宫内胎儿死亡（P=.042）和机械通气（P=.006）差异有统计学意义。基于基线肌酐水平升高而发生 AKI 与肾功能结局显著相关（P<.001），而恢复组和未恢复组之间连续肾脏替代治疗（CRRT）的使用差异有统计学意义（P=.023）。
我们确定了导致与妊娠相关的 AKI 并影响患者预后的相关危险因素。休克、败血症、凝血功能障碍、肝功能不全、产后出血、宫内胎儿死亡和机械通气是与妊娠相关的 AKI 的独立危险因素，而基线肌酐水平升高是不良预后的关键因素。同时，早期 CRRT 可以有效逆转肾脏结局。
