Temporal trends and clinical characteristics associated with pregnancy-related acute kidney injury in England: a population-based cohort study
Bibliographic record
Abstract
Background: Previous studies have reported an increase in pregnancy-related acute kidney injury, but the underlying reasons and patient characteristics associated with this trend are incompletely understood. Objective: To describe temporal trends and identify clinical characteristics associated with pregnancy-related acute kidney injury in England. Study design: This population-based cohort study included all live birth and stillbirth pregnancies to persons aged 15 to 45 years, between 1998 and 2017, using general practitioner practices in England linked to hospitalization data. The outcomes were overall acute kidney injury, postpartum acute kidney injury, severe acute kidney injury, and pulmonary oedema. Adjusted risk ratios were estimated for each 5-year period using Poisson regression models. Results: Among 324,124 pregnancies (4.3% ≥ 40 years, 44.1% nulliparous), acute kidney injury increased from 2.9 to 11.2 per 10,000 pregnancies from 1998-2002 to 2013-2017. Severe acute kidney injury increased from 15.9 to 18.5 per 100,000 pregnancies from 1998-2007 to 2008-2017, while pulmonary oedema decreased from 16 to <5 events per 100,000 pregnancies. Acute kidney injury incidence increased markedly among women with hypertensive disorders and the adjusted risk ratio (aRR) for acute kidney injury among those with hypertensive disorders (vs those without) increased from 1.7 (95% confidence interval [CI] 0.4-8.1) in 1998-2002 to 4.5 (95% CI 2.6-7.7) in 2013 to 2017. There was no notable change in postpartum acute kidney injury among those with postpartum hemorrhage and the aRR for the association of postpartum hemorrhage with acute kidney injury decreased from 18.4 (95% CI 4.3-79.0) in 1998-2002 to 2.5 (95% CI 0.9-6.1) in 2013 to 2017. Few (<5) cases of acute kidney injury occurred among pregnancies with sepsis. Conclusions: There was a marked rise in pregnancy-related acute kidney injury, particularly in last 5 years of the study. The steady rise among those with hypertensive disorders suggests ongoing vigilance is required to ensure optimal care. An investigation of other potential causes or changes in case ascertainment is also warranted given the rise in acute kidney injury among those without hypertensive disorders of pregnancy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".