BackgroundMaternal acute kidney injury (AKI) represents a severe and preventable complication of pregnancy, contributing significantly to maternal and perinatal morbidity and mortality worldwide. Marked disparities persist between low- and middle-income countries (LMICs) and high-income countries (HICs), particularly regarding access to renal replacement therapy (RRT) and critical care support. We aimed to estimate the global incidence among obstetric ICU admissions, risk factors, and outcomes of maternal AKI requiring intensive care, with a specific focus on the burden and prognostic impact of RRT.MethodsThis systematic review and meta-analysis followed the PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Web of Science were searched up to April 2025 for original studies reporting incidence, etiology, and outcomes of maternal AKI in intensive care units (ICUs). Random-effects models were used to pool incidence rates and outcome measures across studies.ResultsEleven studies comprising 3,494 critically ill obstetric patients from seven countries were included. The pooled global incidence of maternal AKI was 2,813 per 10,000 obstetric ICU admissions (95% CI: 1,5-4,5), with the highest rates in African (5,909/10,000) and Western Pacific (2,912/10,000) regions. The predominant etiologies were hypertensive disorders of pregnancy (including HELLP syndrome), obstetric hemorrhage, and sepsis. Among AKI patients, 20.4% required RRT (95% CI: 11.7-33.2), and mortality was 19.4% (95% CI: 12.3-29.2). Renal recovery occurred in 81.8%, while persistent dysfunction was observed in 18.2% of survivors. A strong correlation was found between RRT use and mortality (Spearman's rho = 0.71, p = 0.047).ConclusionsAmong obstetric patients admitted to intensive care units, maternal AKI represents a substantial clinical burden, with a significant proportion of affected women requiring RRT-a marker of disease severity strongly associated with increased mortality. Despite generally favorable renal recovery among survivors, profound regional disparities persist. These estimates apply exclusively to obstetric ICU admissions and should not be extrapolated to the general pregnant population. Early identification, standardized diagnostic criteria, and equitable access to renal replacement therapies remain critical priorities to improve maternal outcomes in intensive care settings.
Global incidence of acute kidney injury and renal replacement therapy among obstetric intensive care unit admissions: a systematic review and meta-analysis
Pota, Vincenzo;Coppolino, Francesco;Fiore, Marco;Giaccari, Luca Gregorio;Passavanti, Maria Beatrice;Pace, Maria Caterina;Sansone, Pasquale
2026
Abstract
BackgroundMaternal acute kidney injury (AKI) represents a severe and preventable complication of pregnancy, contributing significantly to maternal and perinatal morbidity and mortality worldwide. Marked disparities persist between low- and middle-income countries (LMICs) and high-income countries (HICs), particularly regarding access to renal replacement therapy (RRT) and critical care support. We aimed to estimate the global incidence among obstetric ICU admissions, risk factors, and outcomes of maternal AKI requiring intensive care, with a specific focus on the burden and prognostic impact of RRT.MethodsThis systematic review and meta-analysis followed the PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Web of Science were searched up to April 2025 for original studies reporting incidence, etiology, and outcomes of maternal AKI in intensive care units (ICUs). Random-effects models were used to pool incidence rates and outcome measures across studies.ResultsEleven studies comprising 3,494 critically ill obstetric patients from seven countries were included. The pooled global incidence of maternal AKI was 2,813 per 10,000 obstetric ICU admissions (95% CI: 1,5-4,5), with the highest rates in African (5,909/10,000) and Western Pacific (2,912/10,000) regions. The predominant etiologies were hypertensive disorders of pregnancy (including HELLP syndrome), obstetric hemorrhage, and sepsis. Among AKI patients, 20.4% required RRT (95% CI: 11.7-33.2), and mortality was 19.4% (95% CI: 12.3-29.2). Renal recovery occurred in 81.8%, while persistent dysfunction was observed in 18.2% of survivors. A strong correlation was found between RRT use and mortality (Spearman's rho = 0.71, p = 0.047).ConclusionsAmong obstetric patients admitted to intensive care units, maternal AKI represents a substantial clinical burden, with a significant proportion of affected women requiring RRT-a marker of disease severity strongly associated with increased mortality. Despite generally favorable renal recovery among survivors, profound regional disparities persist. These estimates apply exclusively to obstetric ICU admissions and should not be extrapolated to the general pregnant population. Early identification, standardized diagnostic criteria, and equitable access to renal replacement therapies remain critical priorities to improve maternal outcomes in intensive care settings.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
