Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study

Abstract

Objective: To examine whether changes in postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors explain the increase in obstetric acute renal failure in Canada.

Design: Retrospective cohort study.

Setting: Canada (excluding the province of Quebec).

Participants: All hospital deliveries from 2003 to 2010 (n=2,193,425).

Main outcome measures: Obstetric acute renal failure identified by ICD-10 diagnostic codes.

Methods: Information on all hospital deliveries in Canada (excluding Quebec) between 2003 and 2010 (n=2,193,425) was obtained from the Canadian Institute for Health Information. Temporal trends in obstetric acute renal failure were assessed among women with and without postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors. Logistic regression was used to determine if changes in risk factors explained the temporal increase in obstetric acute renal failure.

Results: Rates of obstetric acute renal failure rose from 1.66 to 2.68 per 10,000 deliveries between 2003-04 and 2009-10 (61% increase, 95% confidence interval 24% to 110%). Adjustment for postpartum haemorrhage, hypertensive disorders, and other factors did not attenuate the increase. The temporal increase in acute renal failure was restricted to deliveries with hypertensive disorders (adjusted increase 95%, 95% confidence interval 38% to 176%), and was especially pronounced among women with gestational hypertension with significant proteinuria (adjusted increase 171%, 71% to 329%). No significant increase occurred among women without hypertensive disorders (adjusted increase 12%, -28 to 72%).

Conclusions: The increase in obstetric acute renal failure in Canada between 2003 and 2010 was restricted to women with hypertensive disorders and was especially pronounced among women with pre-eclampsia. Further study is required to determine the cause of the increase among women with pre-eclampsia.

Rates of obstetric acute renal failure (OARF) among deliveries with and without postpartum haemorrhage and among women with gestational hypertension with significant proteinuria, hypertensive disorders of pregnancy, and no hypertension, Canada (excluding Quebec), 2003-10. Rate ratios express changes between 2003 and 2010 and show that temporal patterns in OARF were different among women with and without hypertension (but not among women with and without postpartum haemorrhage)