O24 ACUTE KIDNEY INJURY IN PREGNANCY AND CARDIO-RENAL OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Background and Objective: Acute kidney injury (AKI) is a common problem in pregnancy but adverse cardio-renal outcomes following AKI in pregnancy has not been systematically evaluated. We aimed to quantify the risk of adverse cardio-renal outcomes of AKI in pregnancy. Method: A literature search was conducted on MEDLINE, Cochrane library and EMBASE from inception until January 2024. The titles, abstracts and full studies were separately screened by two reviewers. Studies were included if they considered pregnant women with AKI, compared them to pregnant women without AKI and included predetermined renal or cardiac outcomes. References from relevant systematic reviews were included if they met the inclusion criteria. Data was independently collected by two reviewers. Any discrepancy was addressed by a third author. The data was analysed using Revman 5. Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Results: We included 17 studies. There is a significantly increased risk of maternal mortality (OR 9.70, 95% CI 3.49, 26.97), ICU admission (OR 3.86, 95% CI 1.93, 7.71), stroke (OR 22.92, 95% CI 2.32, 226.65), thrombotic microangiopathy (OR 9.62, 95% CI 1.57, 57.67), heart failure (OR 22.55, 95% CI 4.39, 115.71) and need for dialysis (OR 408.99, 95% CI 1.23, 135716.45) in pregnant women with AKI compared to women without AKI. Furthermore, there is an increased risk of composite renal disease (chronic kidney disease, renal replacement therapy and end-stage renal failure (OR 52.37, 95% CI 4.67, 587.63) and composite cardiovascular disease (OR 20.6, 95% CI 14.7, 28.9) amongst pregnant patients with AKI compared to non-AKI patients. The composite outcomes are compiled using follow-up data over at least 1 year or more and reflect long-term outcomes. Conclusions: We show that AKI in pregnancy is associated with adverse cardio-renal outcomes. Therefore, careful monitoring and follow-up of patients with AKI in pregnancy are needed to improve the cardio-renal outcomes of this high-risk group of women.

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