Format

Send to:

Choose Destination
See comment in PubMed Commons below
BMJ. 2014 Jul 30;349:g4731. doi: 10.1136/bmj.g4731.

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

Author information

  • 1Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada azar@alumni.ubc.ca.
  • 2Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, ON, Canada.
  • 3Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
  • 4Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
  • 5Department of Pediatrics, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
  • 6Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada.

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.

© Mehrabadi et al 2014.

PMID:
25077825
[PubMed - indexed for MEDLINE]
PMCID:
PMC4115671
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk