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VOLUME 24 , ISSUE 8 ( August, 2020 ) > List of Articles


Comparison of Standard Conservative Treatment and Early Initiation of Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: A Single-center Prospective Study

Abhinav Banerjee, Gesu Mehrotra

Citation Information : Banerjee A, Mehrotra G. Comparison of Standard Conservative Treatment and Early Initiation of Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: A Single-center Prospective Study. Indian J Crit Care Med 2020; 24 (8):688-694.

DOI: 10.5005/jp-journals-10071-23537

License: CC BY-NC 4.0

Published Online: 14-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction and objective: Pregnancy-related acute kidney injury (PRAKI) is one of the most important cause of maternal and fetal morbidity and mortality. Some of the reasons behind PRAKI may be due to sepsis, postpartum hemorrhage, preeclampsia, thrombotic microangiopathies (TMA), and acute fatty liver of pregnancy (AFLP). The timing of initiation of renal replacement therapy (RRT) for better patient outcome is still debatable. We conducted this study to establish whether earlier initiation of RRT in PRAKI improves fetomaternal survival compared to a more conservative approach. Materials and methods: This is a prospective study, where patients were screened at a multispecialty tertiary care hospital in north India for 1 year. The patients were divided into two groups: early RRT and standard AKI treatment. The demographic profile and clinical characteristics of the patients in terms of age, parity access to antenatal care, fetal outcome, urine output, hematological and biochemical profiles, RRT, duration of hospitalization, recovery of renal function, and patients survival were recorded. Results: This prospective study conducted included 13 patients in the early RRT group and 23 patients in the standard group. Considering the fetal outcome, the number of fetal deaths in early RRT group were 14.29%, whereas for the standard group it was 85.71%. In all, 75% of early RRT group and 25% of standard group had normal term delivery. Probability test applied showed they were statistically significant. One maternal mortality was there in the standard group. The indices of maternal outcome in PRAKI patients were found to be statistically insignificant. Conclusion: The planning of RRT whether early or late does not make a difference in maternal mortality or morbidity. The fetal outcome is significantly better for patients with early RRT than conservative treatment in PRAKI.

  1. Siribamrungwong M, Chinudomwong. P. Relation between acute kidney injury and pregnancy-related factors. J Acute Dis 2016;5(1):22–28. DOI: 10.1016/j.joad.2015.08.002.
  2. Stratta P, Besso L, Canavese C, Grill A, Todros T, Benedetto C, et al. Is pregnancy-related acute renal failure a disappearing clinical entity? Ren Fail 1996;18(4):575–584. DOI: 10.3109/08860229609047680.
  3. Prakash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK, Srivastava PK, et al. Acute renal failure in pregnancy in a developing country: twenty years of experience. Ren Fail 2006;28(4):309–313. DOI: 10.1080/08860220600583658.
  4. Pertuiset N, Grünfeld JP. Acute renal failure in pregnancy. Baillieres Clin Obstet Gynaecol 1994;8(2):333–351. DOI: 10.1016/s0950-3552(05)80324-4.
  5. Chugh KS. Etiopathogenesis of acute renal failure in the tropics. Ann Natl Acad Med Sci (India) 1987;3:88–99.
  6. Kilari SK, Chinta RK, Vishnubhotla SK. Pregnancy related acute renal failure. J Obstet Gynecol India 2006;56:308–310.
  7. Prakash J, Tripathi K, Malhotra V, Kumar O, Srivastava PK. Acute renal failure in eastern India. Nephrol Dial Transplant 1995;10(11):2009–2012.
  8. Maikranz P, Katz AI. Acute renal failure in pregnancy. Obstet Gynecol Clin North Am 1991;18(2):333–343.
  9. Prakash J, Tripathi K, Pandey LK, Gadela SR. Usha renal cortical necrosis in pregnancy-related acute renal failure. J Indian Med Assoc 1996;94(6):227–229.
  10. Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K, et al. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India. Nephrol Dial Transplant 2007;22(4):1213–1217. DOI: 10.1093/ndt/gfl761.
  11. Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Magee LA, Kramer MS, et al. Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. BMJ 2014;349(jul30 2):g4731. DOI: 10.1136/bmj.g4731.
  12. Jamale TE, Hase NK, Kulkarni M, Pradeep KJ, Keskar V, Jawale S, et al. Earlier-start versus usual-start dialysis in patients with community-acquired acute kidney injury: a randomized controlled trial. Am J Kidney Dis 2013;62(6):1116–1121. DOI: 10.1053/j.ajkd.2013.06.012.
  13. Bouman CSC, Oudemans-Van Straaten HM, Tijssen JGP, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002;30(10):2205–2211. DOI: 10.1097/00003246-200210000-00005.
  14. Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 2016;375(2):122–133. DOI: 10.1056/NEJMoa1603017.
  15. Zarbock A, Gerß J, Van Aken H, Boanta A, Kellum JA, Meersch M. Early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury (the ELAIN-trial): Study protocol for a randomized controlled trial. Trials 2016;17(1):148. DOI: 10.1186/s13063-016-1249-9.
  16. Wald R, Adhikari NK, Smith OM, Weir MA, Pope K, Cohen A, et al. Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury. Kidney Int 2015;88(4):897–904. DOI: 10.1038/ki.2015.184.
  17. Bhatt GC, Das RR. Early versus late initiation of renal replacement therapy in patients with acute kidney injury-a systematic review & meta-analysis of randomized controlled trials. BMC Nephrol 2017;18(1):78. DOI: 10.1186/s12882-017-0486-9.
  18. Wierstra BT, Kadri S, Alomar S, Burbano X, Barrisford GW, Kao RLC. The impact of “early” versus “late” initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis. Crit Care 2016;20(1):122. DOI: 10.1186/s13054-016-1291-8.
  19. Gammill HS, Jeyabalan A. Acute renal failure in pregnancy. Crit Care Med 2005;33((Suppl.):S372–S384. DOI: 10.1097/01.ccm.0000183155.46886.c6.
  20. Davison JM, Dunlop W. Renal haemodynamics and tubular function in normal human pregnancy. Kidney Int 1980;18(2):152. DOI: 10.1038/ki.1980.124.
  21. Sturgiss SV, Dunlop W, Davison JM. Renal hemodynamics and tubular function in human pregnancy. Baillieres Clin Obstet Gynaecol 1994;8(2):209. DOI: 10.1016/s0950-3552(05)80319-0.
  22. Goplani K, Shah P, Gera D, Gumber M, Dabhi M, Feroz A, et al. Pregnancy-related acute renal failure: a single-center experience. Indian J Nephrol 2008;18(1):17–21. DOI: 10.4103/0971-4065. 41283.
  23. Krishna A, Singh R, Prasad N, Gupta A, Bhadauria D, Kaul A, et al. Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis. 2015;25(Issue 2):77–81. DOI: 10.4103/0971-4065.136890.
  24. Hachim K, Badahi K, Benghanem M, Fatihi EM, Zahiri K, Ramdani B, et al. Obstetrical acute renal failure. Experience of the nephrology department, central university hospital Ibn Rochd, Casablanca. Nephrologie 2001;22(1):29–31.
  25. Chugh KS, Krishna CR, Sharma BK. ARF of obstetric origin. J Obstet Gynecol 1976;108:253–261.
  26. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis 1998;31(5):756–765. DOI: 10.1016/s0272-6386(98)70060-5.
  27. Hou S. Pregnancy in dialysis patients: where do we go from here? Semin Dial 2003;16(5):376–378. DOI: 10.1046/j.1525-139x.2003.16083.x.
  28. Naylor DF, Olson MM. Critical care obstetrics and gynecology. Crit Care Clin 2003;19(1):127–149. DOI: 10.1016/s0749-0704(02)00059-3.
  29. Gangji AS, Windrim R, Gandhi S, Silverman JA, Chan CM. Successful pregnancy with nocturnal hemodialysis. Am J Kidney Dis 2004;44(5):912–916. DOI: 10.1016/S0272-6386(04)01090-X.
  30. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis 1998;31(5):766–773. DOI: 10.1016/s0272-6386(98)70044-7.
  31. Prasad S, Parkhurst D, Morton MR, Henning P, Lawton J, Bannister K. Increased delivery of haemodialysis assists successful pregnancy outcome in end-stage renal failure. Nephrology 2003;8(6):311–314. DOI: 10.1111/j.1440-1797.2003.00208.x.
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