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Obstetric Quality and Safety

Poster Session 2

(496) Defining Maternal Renal Morbidity: Application of Staging Systems to Peripartum Acute Kidney Injury

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Thomas P. Kishkovich, MD (he/him/his)

OB/GYN Resident
Brigham and Women's Hospital & Massachusetts General Hospital, Department of Obstetrics and Gynecology
Boston, MA, United States

Coauthor(s)

AK

Abigail M. Kempf, BA

Brigham and Women's Hospital
Boston, MA, United States
AP

Andrea Pelletier, MPH, MS

Brigham and Women's Hospital
Boston, MA, United States
NP

Nicole M. Patton, PA-C

Brigham and Women's Hospital
Boston, MA, United States
Michaela K. Farber, MD, MS (she/her/hers)

Chief
Brigham and Women's Hospital
Boston, MA, United States
NS

Nicole Smith, MD,MPH

Associate Professor
Brigham and Women's Hospital, Harvard Medical School
Boston, MA, United States

Objective: Acute kidney injury (AKI) is one of 21 severe maternal morbidity (SMM) diagnoses. Aiming to address maternal morbidity, appropriate recognition and response to AKI are essential. ACOG/SMFM have released conservative guidelines for AKI diagnosis. We reviewed our institution’s obstetric AKI cases to establish characteristics and outcomes for AKI severity in the context of these staging systems.

Study Design: This study was a retrospective cohort study of AKI cases (ICD 10 code N17.0-17.9) between 01/2018 - 12/2022 at a single academic institution with ~6,000 births annually. Information was extracted via chart review. Cases were stratified by Acute Kidney Injury Network (AKIN) staging and ACOG/SMFM severe renal injury criteria. Those with unknown baseline creatinine (Cr) were assigned 0.7 (the 95th% Cr value at 39-40 weeks). Groups were compared based on demographics, comorbidities, and outcomes (Table 1).

Results: 230 cases were reviewed for AKI severity: 8.3% (19 cases) met criteria by ACOG/SMFM criteria. There were no significant differences in baseline demographics, medication dependent diabetes, chronic kidney disease (CKD), or use of gentamicin. Cesarean delivery and hypertension rates were high among all groups. Higher AKIN stage was associated with higher rates of infection (p=0.019) and use of ketorolac (p=0.020); which was not seen in ACOG/SMFM comparison groups. PPH rates were similar among groups; however, more severe AKI was associated with higher EBL (p=0.019 and p< 0.001, respectively). Worse AKI severity was associated with longer time for Cr resolution and higher co-incidence of other SMM in both groups, and longer maternal length of stay in the ACOG/SMFM group.

Conclusion: Peripartum AKI often occurred in the presence of multiple risk factors, including cesarean delivery, hypertension, infection, and hemorrhage. AKI meeting Stage 3 AKIN or ACOG/SMFM were associated with increased morbidity. Caution may be warranted in using AKIN Stage 1 or 2 AKI criteria as it may falsely elevate institutional reporting of SMM, and conservative AKI criteria may better reflect true maternal morbidity.