FREQUENCY OF DIALYSIS DEPENDENCY IN OBSTETRIC ACUTE KIDNEY INJURY

Abstract

Background: Pregnancy-related acute kidney injury (AKI) remains a significant contributor to maternal morbidity and mortality, particularly in low-resource settings where access to timely obstetric and nephrology care is limited. ¹ Dialysis dependency, defined as the requirement for ongoing renal replacement therapy beyond the acute period, signifies progression toward chronic kidney disease and increased long-term morbidity. ². Despite its clinical importance, region-specific data on dialysis dependency post-obstetric AKI are scarce. Methods: We conducted a prospective cross-sectional study at the Department of Nephrology, Lady Reading Hospital (LRH), Peshawar, between June and November 2024, enrolling 133 women aged 18–40 years with KDIGO-defined obstetric AKI ³. Dialysis dependency was defined as requiring ≥12 hemodialysis sessions within one month of AKI onset. ⁴. Comprehensive demographic, obstetric, socioeconomic, and clinical data (age, gestational age, parity, body mass index [BMI], hypertensive disorders, gestational diabetes, prior abortions, education level, occupation, and rural/urban residence) were collected. Data analysis included descriptive statistics and chi-square tests for stratified associations ⁵. Results: Of the study cohort (mean age 28.5 ± 5.2 years; gestational age 36.0 ± 3.4 weeks), 90 (67.7%) had hypertensive disorders and 60 (45.1%) were primigravida. Overall, 89 (66.9%) met dialysis dependency criteria. ⁶. Age-stratified dependency rates were 60% (<25 years), 72% (25–30 years), and 70% (>30 years) (p=0.48) ⁷. Hypertensive patients had a significantly higher dependency rate than normotensive counterparts (77.8% 44.2%) ⁸. No significant associations were observed for parity, BMI category, prior abortions, education, occupation, socioeconomic status, or residence ⁹. These results align with regional cohorts reporting high dependency rates but contrasting sharply with lower rates in high-resource settings. ¹⁰. Conclusion: The findings highlight the urgent need for enhanced antenatal screening, early AKI recognition, and expansion of dialysis services for pregnant populations in resource-limited environments.