Electronic records covering 4,094,111 US pregnancies showed severe pregnancy-associated acute kidney injury rising from 9.0 to 27.6 per 10,000 pregnancies between 2012-2013 and the COVID-19 era. Pre-existing cardiometabolic vulnerability was associated with risk, but observational data cannot separate infection, access, testing, and secular trends.
Key findings
- Incidence rose nearly threefold, from 9.0 per 10,000 in 2012-2013 to 27.6 per 10,000 in 2020-2022. Associations included chronic hypertension (aOR 1.64), obesity (1.60), diabetes (1.37), hyperlipidemia (1.27), chronic kidney disease (1.21), maternal age (1.02 per reported unit), and COVID-19 (1.12). Mortality rose during COVID-19 while dialysis proportions remained stable.
Why this matters globally
The large dataset reveals a health-system trend and supports coordination among obstetrics, nephrology, critical care, and primary care. US risk estimates should not be transferred directly to other health systems.
Thai researcher contribution
Prof. Nattachai Srisawat of Chulalongkorn University and the Academy of Science, Royal Society of Thailand joined an international nephrology and maternal-medicine network. All patient data were from the United States, not Thailand.
Limitations to consider
EHR data may contain missingness, unequal testing, and misclassification. A first very low eGFR can include advanced chronic kidney disease. Preeclampsia, sepsis, race, socioeconomic status, and care access may leave residual confounding. A COVID-era increase is temporal association, not proof that COVID-19 caused the trend.
Verify the original sources
Nephrology Dialysis TransplantationRead the original article↗DOI: 10.1093/ndt/gfag152