Pregnancy-Related Acute Kidney Injury in low- and middle-income countries: Prevention Key to Better Outcomes
Researchers have found in a new study that pregnancy-associated acute kidney injury poses a major risk to maternal health in low- and middle-income countries. Therefore strengthening prevention strategies for common causes and expanding antenatal care access can help minimize harmful effects on both mothers and babies. The study was published in the journal of Bull World Health Organ by Tran PNT and colleagues.
The review summarised data from 43 studies, and 40 of these went into the final meta-analysis. Search databases covered Cochrane Central Register of Controlled Trials, Embase, Google Scholar, OvidMedline, ProQuest, and Scopus for studies published between 2013 and 2025. Exclusively, the studies based on the Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria were considered for statistical pooling. The study also performed subgroup analysis and meta-regression to assess factors underlying heterogeneity in results.
Key findings
The combined incidence of PA-AKI was 91 cases per 10,000 pregnancies (95% CI: 63–133).
The incidence was highest in World Health Organization African Region studies, where it was 254 per 10,000 pregnancies (95% CI: 152–421).
These results indicate that the burden of PA-AKI is unevenly distributed and is heavily dependent on regional healthcare infrastructure and maternal health resources.
The condition was linked to high maternal and neonatal mortality.
The fatality of the case was 10.8% (95% CI: 7.6–15.3), and death during neonatal life or stillbirth resulted in 29.8% of the cases (95% CI: 24.2–36.1).
Additionally, mothers with PA-AKI had an 18.8 times increased risk of maternal death (95% CI: 10.0–35.5) compared to those without the condition, and there was a 4.6 times increased risk (95% CI: 2.1–10.0) of poor fetal outcomes, such as preterm birth and low birth weight.
Pre-eclampsia emerged as the most common cause of PA-AKI, at 44.1% of the cases, followed by hemorrhage (26.2%) and sepsis (16.5%).
These etiologies underscore the preventable nature of most cases of PA-AKI through early obstetric intervention, infection control, and enhanced maternal monitoring during pregnancy.
The research points to the fact that PA-AKI is a significant public health threat among LMICs, with a high risk of mortality for both mother and fetus. Interventions targeted specifically towards public health programs and strengthened maternal healthcare facilities can go a long way toward mitigating incidence and outcomes of PA-AKI in low-resource environments.
Reference:
Tran, P. N. T., Wannakittirat, A., Luyckx, V., Wiles, K., Yadla, M., Chakravarthi, R., Ostermann, M., Wu, V. C., Mehta, R. L., & Srisawat, N. (2025). Incidence of pregnancy-associated acute kidney injury in low- and middle-income countries: a meta-analysis. Bulletin of the World Health Organization, 103(8), 493–506. https://doi.org/10.2471/BLT.24.293077
