Incidence of CKD and Death among Reproductive Age Women with Dialysis Requiring Acute Kidney Injury in Ethiopia: The Role of Obstetric Risk Factors

ABSTRACT Background Obstetric risk factors are among the leading preventable causes of Acute Kidney Injury (AKI) in hospitalized reproductive age women. Obstetric-related AKI (ORAKI) has been linked to a significant increase in the overall burden of AKI in resource-constrained settings, resulting in poor maternal and perinatal outcomes. As a result, understanding the impact of these factors on the progression of AKI is critical for a positive outcome. The study sought to determine the incidence of CKD and death, and the effect of obstetric risk factors on these outcomes among reproductive age women with dialysis requiring AKI at the national renal transplant center in Ethiopia. Methods A retrospective cohort study was conducted on 127 AKI cases (57 ORAKI and 70 None-ORAKI) who were on dialysis at the center from January 2018 to June 2020. A posthoc power analysis was calculated using G*Power 3.19.4. Data characterization and comparison was made using frequencies with percentages, median with interquartile range, chi-square test/ Fischer’s exact test and Mann-Whitney U test. A Robust Poisson regression model was used to identify factors that influence the progression of AKI to CKD and death, with Adjusted Relative Risk (ARR), 95% CIs for ARR, and P-values reported for result interpretation. Results The overall incidence rate (IR) of CKD was 5.4 per 1000 Person-days (PD) (ORAKI group=0 and None-ORAKI group= 9.7 per 1000 PD) and the overall incidence rate of death was 7.8 per 1000 PD (ORAKI group=5.5 per 1000 PD and None-ORAKI group= 9.7 per 1000 PD). According to the multivariable regression analysis, participants with ORAKI had a 22% lower risk of progression to CKD or death than those with None-ORAKI (ARR=0.78, 95%CI=0.67-0.90, p=0.001). Conclusions Although having obstetric related risk factors has been linked to an increased risk of developing AKI, once it occurs, those with ORAKI have a significantly better prognosis than those with None-ORAKI. Continued efforts to prevent AKI in pregnant women and to slow its progression once it has developed are critical for a better maternal and fetal outcome.