Acute kidney injury in critically ill patients with hypertensive disorders of pregnancy: a prospective cohort study.

OBJECTIVES: To identify clinical and biochemical factors associated with the development of acute kidney injury (AKI) in critically ill patients with severe hypertensive disorders of pregnancy (HDP) and to evaluate associated maternal and fetal outcomes. STUDY DESIGN: A prospective single-center cohort study was conducted in an Argentinian intensive care unit (ICU) between November 2017 and July 2022, including 179 women with severe HDP. MAIN OUTCOME MEASURES: The primary outcome was the development of AKI, defined by either a pregnancy-adjusted admission serum creatinine threshold (>0.87 mg/dL) or fulfillment of Kidney Disease Improving Global Outcomes (KDIGO) criteria. Secondary outcomes included maternal and fetal mortality. RESULTS: Out of 179 patients, AKI was diagnosed in 119 patients (66.3%) and was associated with higher illness severity scores and increased fetal mortality (18% vs. 5%; p = 0.022), In the final multivariable analysis, independent predictors of AKI included the corrected Sequential Organ Failure Assessment (SOFA) score (OR 1.37; 95% CI 1.04-1.81), serum uric acid (OR 1.03; 95% CI 1.01-1.05), lactate dehydrogenase (OR 1.01; 95% CI 1.00-1.01), and base excess (OR 0.87; 95% CI 0.78-0.96). HELLP syndrome represented the most severe phenotype, carrying the highest risk for advanced AKI and the need for renal replacement therapy. CONCLUSIONS: AKI is highly prevalent in critically ill patients with severe HDP and serves as a key determinant of adverse maternal and fetal prognosis, Simple biochemical markers and organ dysfunction scores enable early risk stratification, the limited specificity of standard criteria highlights the necessity for pregnancy-adapted diagnostic approaches.