Incidence of pregnancy-associated acute kidney injury in low- and middle-income countries: a meta-analysis.

OBJECTIVE

To conduct a systematic review and meta-analysis of pregnancy-associated acute kidney injury in low- and middle-income countries.

METHOD: We searched the databases Cochrane Central Register of Controlled Trials, Embase, Google Scholar, OvidMedline, ProQuest and Scopus for articles published during 2013-2025 reporting the incidence, etiology and outcomes of the condition in low- and middle-income countries. We conducted a meta-analysis of the studies that used the diagnostic criteria of the Kidney Disease: Improving Global Outcomes organization. We conducted subgroup analyses and a meta-regression to explore sources of heterogeneity.

FINDINGS: We reviewed 43 studies and included 40 in our meta-analysis, covering 424 081 pregnancies in 15 low- and middle-income countries. We observed a pooled incidence of 91 cases (95% confidence interval, CI: 63-133) per 10 000 pregnancies, highest in studies conducted in the World Health Organization African Region (254; 95% CI: 152-421). We estimated case fataliy of 10.8% (95% CI: 7.6-15.3) and neonatal death or stillbirth in 29.8% of cases (95% CI: 24.2-36.1). We observed that the condition was associated with 18.8-fold higher odds of maternal death (95% CI: 10.0-35.5) and 4.6-fold higher odds of adverse fetal outcomes (95% CI: 2.1-10.0). We identified pre-eclampsia (44.1%), haemorrhage (26.2%) and sepsis (16.5%) as the leading etiologies.

CONCLUSION

Pregnancy-associated acute kidney injury is a significant maternal health concern in low- and middle-income countries. By providing more resources to prevent the common etiologies and expand the availability of antenatal care, its deleterious effects on maternal and fetal outcomes can be reduced.