The INAPRES (Indonesia preeclampsia study): Clinical outcomes of acute kidney injury related to preeclampsia in Indonesia.

OBJECTIVE

To evaluate acute kidney injury (AKI) as a marker of disease severity in preeclampsia (PE) and its association with maternal and neonatal outcomes.

METHODS

This retrospective multicenter cohort study analyzed data from the Indonesia Preeclampsia Study (INAPRES), including preeclamptic pregnancies managed in 30 referral hospitals across Indonesia between January 2022 and December 2023. AKI was defined using RIFLE criteria. Maternal characteristics, maternal complications, and perinatal outcomes were compared between women with and without AKI. Multivariable logistic regression identified independent risk factors, maternal, and perinatal outcomes associated with AKI.

RESULTS

Among 1,808 pregnancies complicated by PE, 53 (2.9%) developed AKI, reflecting advanced disease along the hypertensive continuum. AKI was independently associated with increased risks of maternal death (adjusted odds ratio [aOR] 4.99; 95% CI 1.65-15.16), pulmonary edema (aOR 3.52; 95% CI 1.73-7.17), HELLP syndrome (aOR 3.58; 95% CI 1.96-6.55), ICU admission (aOR 1.99; 95% CI 1.07-3.72), and preterm birth before 34 weeks (aOR 2.51; 95% CI 1.36-4.62). Neonates born to mothers with AKI were delivered earlier, had lower birthweights, and more frequently had low Apgar scores at 1 and 5 min. Pre-existing renal disease (aOR 42.95; 95% CI 14.57-126.62) and multiparity (aOR 2.38; 95% CI 1.05-5.38) were independently associated with AKI.

CONCLUSION

Within hypertensive disorders of pregnancy, AKI represents a critical escalation of disease severity and is associated with substantial maternal and neonatal risk. Routine renal function assessment in PE may enhance risk stratification and guide timely escalation of care, particularly in resource-limited settings.