title: Pregnancy Outcomes after Clinical Recovery from AKI.
abstract: The effect of clinically recovered AKI (r-AKI) on future pregnancy outcomes is unknown. We retrospectively studied all women who delivered infants between 1998 and 2007 at Massachusetts General Hospital to assess whether a previous episode of r-AKI associated with subsequent adverse maternal and fetal outcomes, including preeclampsia. AKI was defined as rise in serum creatinine concentration to 1.5-fold above baseline. We compared pregnancy outcomes in women with r-AKI without history of CKD (eGFR>90 ml/min per 1.73 m2before conception;n=105) with outcomes in women without kidney disease (controls;n=24,640). The r-AKI and control groups had similar prepregnancy serum creatinine measurements (0.70±0.20 versus 0.69±0.10 mg/dl;P=0.36). However, women with r-AKI had increased rates of preeclampsia compared with controls (23% versus 4%;P<0.001). Infants of women with r-AKI were born earlier than infants of controls (37.6±3.6 versus 39.2±2.2 weeks;P<0.001), with increased rates of small for gestational age births (15% versus 8%;P=0.03). After multivariate adjustment, r-AKI associated with increased risk for preeclampsia (adjusted odds ratio [aOR], 5.9; 95% confidence interval [95% CI], 3.6 to 9.7) and adverse fetal outcomes (aOR, 2.4; 95% CI, 1.6 to 3.7). When women with r-AKI and controls were matched 1:2 by age, race, body mass index, diastolic BP, parity, and diabetes status, r-AKI remained associated with preeclampsia (OR, 4.7; 95% CI, 2.1 to 10.1) and adverse fetal outcomes (OR, 2.1; 95% CI, 1.2 to 3.7). Thus, a past episode of AKI, despite return to normal renal function before pregnancy, associated with adverse outcomes in pregnancy.
authors.affiliation: Division of Nephrology, Department of Medicine, jtangren@partners.org.
authors.forename: Jessica Sheehan
authors.initials: JS
authors.lastname: Tangren
authors.affiliation: Division of Endocrinology, Department of Medicine, and.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Powe
authors.affiliation: Division of Nephrology, Department of Medicine.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ankers
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ecker
authors.affiliation: Department of Renal Medicine, King's College London and King's Health Partners, London, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Bramham
authors.affiliation: Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Hladunewich
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.affiliation: Division of Nephrology, Department of Medicine.
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acute renal failure; clinical epidemiology; preeclampsia; pregnancy