Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization

Silvi Shah; Karthikeyan Meganathan; Annette L Christianson; Kathleen Harrison; Anthony C Leonard; Charuhas V Thakar

doi:10.1159/000505894

Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization

Silvi Shah
, Karthikeyan Meganathan
, Annette L Christianson
, Kathleen Harrison
, Anthony C Leonard
, Charuhas V Thakar

Research output: Contribution to journal › Article › peer-review

45 Citations (Scopus)

41 Downloads (Pure)

Abstract

BACKGROUND: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied.

METHODS: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations.

RESULTS: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95% CI 1.36-1.64) and 41-49 years (OR 2.12; 95% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95% CI 1.40-1.65) and Native Americans (OR 1.45; 95% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47-17.42) and CV events (OR 9.74; 95% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447).

CONCLUSION: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

Original language	English
Pages (from-to)	216-226
Number of pages	11
Journal	American Journal of Nephrology
Volume	51
Issue number	3
Early online date	11 Feb 2020
DOIs	https://doi.org/10.1159/000505894
Publication status	Published - Mar 2020
Externally published	Yes

Bibliographical note

The Author(s). Published by S. Karger AG, Basel.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Acute Kidney Injury/complications
Adolescent
Adult
Black or African American/statistics & numerical data
Female
Heart Disease Risk Factors
Hospital Mortality
Hospitalization/statistics & numerical data
Humans
Male
Middle Aged
Patient Acceptance of Health Care/statistics & numerical data
Pregnancy
Pregnancy Complications, Cardiovascular/epidemiology
Renal Dialysis/statistics & numerical data
Retrospective Studies
United States/epidemiology
White People/statistics & numerical data
Young Adult
American Indian or Alaska Native/statistics & numerical data

Access to Document

10.1159/000505894Licence: CC BY-NC-ND

Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization
Copyright 2020 the authors. This is an open access article published under a Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits distribution and reproduction for non-commercial purposes, provided the author and source are cited.
Final published version, 401 KBLicence: CC BY-NC-ND

Cite this

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title = "Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization",

abstract = "BACKGROUND: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied.METHODS: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations.RESULTS: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08\%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95\% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95\% CI 1.36-1.64) and 41-49 years (OR 2.12; 95\% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95\% CI 1.40-1.65) and Native Americans (OR 1.45; 95\% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95\% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95\% CI 10.47-17.42) and CV events (OR 9.74; 95\% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447).CONCLUSION: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.",

keywords = "Acute Kidney Injury/complications, Adolescent, Adult, Black or African American/statistics \& numerical data, Female, Heart Disease Risk Factors, Hospital Mortality, Hospitalization/statistics \& numerical data, Humans, Male, Middle Aged, Patient Acceptance of Health Care/statistics \& numerical data, Pregnancy, Pregnancy Complications, Cardiovascular/epidemiology, Renal Dialysis/statistics \& numerical data, Retrospective Studies, United States/epidemiology, White People/statistics \& numerical data, Young Adult, American Indian or Alaska Native/statistics \& numerical data",

author = "Silvi Shah and Karthikeyan Meganathan and Christianson, \{Annette L\} and Kathleen Harrison and Leonard, \{Anthony C\} and Thakar, \{Charuhas V\}",

note = "The Author(s). Published by S. Karger AG, Basel.",

year = "2020",

month = mar,

doi = "10.1159/000505894",

language = "English",

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journal = "American Journal of Nephrology",

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}

TY - JOUR

T1 - Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization

AU - Shah, Silvi

AU - Meganathan, Karthikeyan

AU - Christianson, Annette L

AU - Harrison, Kathleen

AU - Leonard, Anthony C

AU - Thakar, Charuhas V

N1 - The Author(s). Published by S. Karger AG, Basel.

PY - 2020/3

Y1 - 2020/3

N2 - BACKGROUND: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied.METHODS: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations.RESULTS: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95% CI 1.36-1.64) and 41-49 years (OR 2.12; 95% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95% CI 1.40-1.65) and Native Americans (OR 1.45; 95% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47-17.42) and CV events (OR 9.74; 95% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447).CONCLUSION: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

AB - BACKGROUND: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied.METHODS: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations.RESULTS: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95% CI 1.36-1.64) and 41-49 years (OR 2.12; 95% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95% CI 1.40-1.65) and Native Americans (OR 1.45; 95% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47-17.42) and CV events (OR 9.74; 95% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447).CONCLUSION: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

KW - Acute Kidney Injury/complications

KW - Adolescent

KW - Adult

KW - Black or African American/statistics & numerical data

KW - Female

KW - Heart Disease Risk Factors

KW - Hospital Mortality

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Acceptance of Health Care/statistics & numerical data

KW - Pregnancy

KW - Pregnancy Complications, Cardiovascular/epidemiology

KW - Renal Dialysis/statistics & numerical data

KW - Retrospective Studies

KW - United States/epidemiology

KW - White People/statistics & numerical data

KW - Young Adult

KW - American Indian or Alaska Native/statistics & numerical data

U2 - 10.1159/000505894

DO - 10.1159/000505894

M3 - Article

C2 - 32045905

SN - 0250-8095

VL - 51

SP - 216

EP - 226

JO - American Journal of Nephrology

JF - American Journal of Nephrology

IS - 3

ER -

Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization

Abstract

Bibliographical note

UN SDGs

Keywords

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Cite this