Incidence of pregnancy-associated acute kidney injury in low- and middle-income countries: a meta-analysis.
Journal
Bulletin of the World Health Organization
Journal Volume
103
Journal Issue
8
Start Page
493
End Page
506
ISSN
1564-0604
Date Issued
2025-08-01
Author(s)
Tran, Phu Nguyen Trong
Wannakittirat, Anyarin
Luyckx, Valerie
Wiles, Kate
Yadla, Manjusha
Chakravarthi, Rajasekara
Ostermann, Marlies
Mehta, Ravindra L
Srisawat, Nattachai
Abstract
Objective To conduct a systematic review and meta-analysis of pregnancy-associated acute kidney injury in low-and middle-income countries. Method We searched the databases Cochrane Central Register of Controlled Trials, Embase, Google Scholar, OvidMedline, ProQuest and Scopus for articles published during 2013–2025 reporting the incidence, etiology and outcomes of the condition in low-and middle-income countries. We conducted a meta-analysis of the studies that used the diagnostic criteria of the Kidney Disease: Improving Global Outcomes organization. We conducted subgroup analyses and a meta-regression to explore sources of heterogeneity. Findings We reviewed 43 studies and included 40 in our meta-analysis, covering 424 081 pregnancies in 15 low-and middle-income countries. We observed a pooled incidence of 91 cases (95% confidence interval, CI: 63–133) per 10 000 pregnancies, highest in studies conducted in the World Health Organization African Region (254; 95% CI: 152–421). We estimated case fataliy of 10.8% (95% CI: 7.6–15.3) and neonatal death or stillbirth in 29.8% of cases (95% CI: 24.2–36.1). We observed that the condition was associated with 18.8-fold higher odds of maternal death (95% CI: 10.0–35.5) and 4.6-fold higher odds of adverse fetal outcomes (95% CI: 2.1–10.0). We identified pre-eclampsia (44.1%), haemorrhage (26.2%) and sepsis (16.5%) as the leading etiologies. Conclusion Pregnancy-associated acute kidney injury is a significant maternal health concern in low-and middle-income countries. By providing more resources to prevent the common etiologies and expand the availability of antenatal care, its deleterious effects on maternal and fetal outcomes can be reduced.
SDGs
Type
journal article