Lesão renal aguda, mortalidade e necessidade de diálise em pacientes admitidas na unidade de terapia intensiva materna, do Hospital Materno Infantil de Brasília (HMIB) DF

Abstract

Introduction: Pregnancy-related acute kidney injury (AKI) can be defined as the abrupt decline of renal function during pregnancy or postpartum period. It’s important cause of maternal and fetal morbidity and mortality. We attempted to classify the renal function of patients admitted to a maternal intensive care unit by KDIGO Criteria and to evaluate the impact of each category on mortality in a maternal ICU. Materials and Methods: This was a retrospective analysis of observational data prospectively collected from January 2014 to April 2016 in the maternal ICU/HMIB, Brasília, Federal District, Brazil. All consecutive patients diagnosed with AKI were included. Patients with a previous diagnosis of renal failure prior to pregnancy or kidney transplantation were excluded. Results: From a total of 619 patients admitted in the ICU during the study period, pregnancy related AKI was present in 172 cases (27.8%). The major causes of ICU admission were eclampsia (n=63, 36.6%), preeclampsia (n=39, 22.7%) and sepsis (n=27, 15.7%). Fifty-three patients had prior arterial systemic hypertension (30.8%) and 15 had heart failure (8.7%). Thirteen parturients received no prenatal care (7.6%) and 133 had cesarian delivery (71.5%). ICU length of stay was 7.6±10.2 days and ICU maternal mortality was 8.7% (n=15), and newborn mortality was 14.5% (n=25). One hundred ten patients were classified as KDIGO 1 (64.0%, ICU mortality rate of 0.9%), 43 as KDIGO 2 (20.9%, ICU mortality rate of 11.1%), and 22 patients as KDIGO 3 (15.1%, ICU mortality rate of 38.5%). Significant difference was observed in the Kaplan–Meier survival curves among KDIGO stages at 28 days, P = 0.00. Thirteen patients needed HD (7.6%). These patients showed greater APACHE II (26±8 vs. 11±6, P = 0.00), need for invasive mechanical ventilation (IMV 92.3% vs. 24.1%, P = 0.00), use of vasopressors (92.3% vs. 11.9%, P = 0.00) and use of blood products transfusion (53.8% vs. 6.9%). Furthermore, patients required HD had lower mean artery pressure at admission (66±25 vs. 93±21 mmHg, P = 0.00) and use of magnesium sulfate therapy (7.7% vs. 74.2%, P = 0.00). None of patients with conservative renal treatment classified as KDIGO stage 3 evolved to death. These aspects reinforce the importance of indication of renal replacement therapy at the appropriate time, as well as to classify AKI, specially, in critical ill patients, since this makes it possible for predict prognosis. Conclusion: KDIGO Criteria was directly related to mortality in the pregnancy-related AKI, notably those who needed renal replacement therapy.In pregnancy related AKI, higher APACHE II, higher SOFA score, lower mean artery pressure, need for IMV, use of vasopressors and use of blood products transfusion were associated with need for HD. Besides, patients that used magnesium sulfate therapy had lower need for HD.