Prerenal Acute Kidney Injury is Still the Most Important Cause for Dialysis in an Obstetric Critical Care Referral Unit of North India: A 3 Year Retrospective Study.

Introduction: Pregnancy-related acute kidney injury (PRAKI) causes substantial maternofoetal health burden in developing countries. The causes of PRAKI are diverse, important ones being haemorrhage, sepsis and preeclampsia in developing countries. Methods: A retrospective study was conducted in the department of Obstetrics and Gynaecology, and Nephrology in an Indian tertiary care hospital from 2017 to 2019. All patients admitted to Obstetric Critical Care Unit (CCU-Obs) who were pregnant or less than 42 days postpartum, with acute kidney injury and required haemodialysis were enrolled in the study and analysed for risk factors and causes of PRAKI. Results: PRAKI occurred in 6.21% admissions in CCU-Obs and 37.42% of these patients required dialysis. Majority were unbooked (85.9%) and referred (65.6%) from other hospitals; 57.8% patients developed AKI postnatally. The main causes for AKI in the current study were prerenal causes (84.4%) like obstetric haemorrhage due to placental abruption and post-partum haemorrhage. Other important causes were severe preeclampsia (23.4%) and sepsis (39%). Many patients had more than one condition leading to AKI. Patients needed 4.98 (average) cycles of dialysis and the average duration of stay in the hospital was 16.89 days. Maternal mortality was seen in a third of the cases, owing to complications of AKI. Preterm delivery was seen in 44%; stillbirth in half the cases and neonatal deaths in a quarter of them. Conclusion: To conclude, the  leading causes of PRAKI requiring dialysis were obstetric haemorrhage, sepsis and preeclampsia. Prompt management and timely referral to a higher institute will decrease the incidence of PRAKI and its complications.