title: Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study.
abstract: OBJECTIVE
  To examine whether changes in postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors explain the increase in obstetric acute renal failure in Canada.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Canada (excluding the province of Quebec).
  
  
  METHODS
  All hospital deliveries from 2003 to 2010 (n=2,193,425).
  
  
  METHODS
  Obstetric acute renal failure identified by ICD-10 diagnostic codes.
  
  
  METHODS
  Information on all hospital deliveries in Canada (excluding Quebec) between 2003 and 2010 (n=2,193,425) was obtained from the Canadian Institute for Health Information. Temporal trends in obstetric acute renal failure were assessed among women with and without postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors. Logistic regression was used to determine if changes in risk factors explained the temporal increase in obstetric acute renal failure.
  
  
  RESULTS
  Rates of obstetric acute renal failure rose from 1.66 to 2.68 per 10,000 deliveries between 2003-04 and 2009-10 (61% increase, 95% confidence interval 24% to 110%). Adjustment for postpartum haemorrhage, hypertensive disorders, and other factors did not attenuate the increase. The temporal increase in acute renal failure was restricted to deliveries with hypertensive disorders (adjusted increase 95%, 95% confidence interval 38% to 176%), and was especially pronounced among women with gestational hypertension with significant proteinuria (adjusted increase 171%, 71% to 329%). No significant increase occurred among women without hypertensive disorders (adjusted increase 12%, -28 to 72%).
  
  
  CONCLUSIONS
  The increase in obstetric acute renal failure in Canada between 2003 and 2010 was restricted to women with hypertensive disorders and was especially pronounced among women with pre-eclampsia. Further study is required to determine the cause of the increase among women with pre-eclampsia.
authors: Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada azar@alumni.ubc.ca.
authors: Azar
authors: A
authors: Mehrabadi
authors: Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, ON, Canada.
authors: Shiliang
authors: S
authors: Liu
authors: Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, ON, Canada.
authors: Sharon
authors: S
authors: Bartholomew
authors: Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors: Jennifer A
authors: JA
authors: Hutcheon
authors: Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors: Laura A
authors: LA
authors: Magee
authors: Department of Pediatrics, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors: Michael S
authors: MS
authors: Kramer
authors: Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada.
authors: Robert M
authors: RM
authors: Liston
authors: Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors: K S
authors: KS
authors: Joseph
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D016015:Logistic Models; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011507:Proteinuria / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors