Assessment of point-of-care creatinine testing in pregnancy: a prospective cohort study in Sierra Leone.

BACKGROUND

Pregnancy-associated acute kidney injury (PrAKI) is a major contributor to maternal and perinatal morbidity and mortality in low-and middle-income countries, where detection is often delayed due to limited access to creatinine testing. Point-of-care creatinine (POC-Cr) devices may offer a practical alternative. We aimed to describe the incidence, resolution, and clinical consequences of presumed PrAKI or kidney dysfunction among high-risk pregnant and postpartum women, and to assess feasibility of POC-Cr testing.

METHODS

We conducted a study of pregnant or postpartum women at high risk of PrAKI at a hospital in Freetown, Sierra Leone (April-August 2023). Eligibility criteria were systolic blood pressure ≥140 mmHg, diastolic ≥90 mmHg, and/or shock index ≥0.9. Women underwent POC-Cr testing at enrolment and 24 and 48 h. PrAKI was defined as POC-Cr >77 μmol/L, or a change ≥26 μmol/L, and staged where possible. Associations with maternal and perinatal outcomes were assessed. Multivariable logistic regression identified risk factors. Feasibility was evaluated by refusal and test failure.

FINDINGS: Of 1746 eligible women, 1669 (96%) were tested; two declined and one failed. PrAKI or chronic kidney disease occurred in 427 (25.6%). Affected women had maternal (15.4%, 66/427 versus 8.7%, 108/1239) and perinatal (19.3%, 23/119 versus 4.8%, 20/413) adverse outcomes (p < 0.0001). At discharge, 47%, 202/427 had unresolved kidney injury or underlying disease. Independent risk factors included age, mean arterial pressure, and pre-eclampsia or eclampsia.

INTERPRETATION: Kidney dysfunction complicates a quarter of pregnancies and is associated with adverse outcomes. POC-Cr testing may enable earlier detection and improved care in resource-limited settings.

FUNDING: This study was funded by the UK Medical Research Council (MR/T038594/1) and the National Institute for Health and Care Research (NIHR133232).