FP801
IMPACT OF ACUTE KIDNEY INJURY SCREENING DURING PRENATAL CARE VISITS IN SENEGALESE WOMEN: A CLUSTER RANDOMIZED TRIAL

INTRODUCTION AND AIMS: In sub-Saharan Africa, pregnancy-related acute kidney injury (PR-AKI) is a major public health concern associated with adverse outcomes in absence of adequate and timely management. This study aimed to assess the impact of integrating AKI screening and management during prenatal care (PNC) visits on renal outcomes and mortality of women with PR-AKI.

METHODS: We performed a cluster randomized trial including four Senegalese health districts. In each district, we selected a primary healthcare center (PHC), a level-1 hospital and a level-2 hospital. Between January 1^st and December 31^st 2017, we enrolled 4598 and 4533 pregnant women respectively in intervention and control districts. Women with previously known chronic kidney disease were not included. AKI was defined according to KDIGO criteria. Standard PNC were provided in all PHCs and level-1 hospitals but those in intervention health districts provided additional AKI screening (clinical examination, urine dipsticks and serum creatinine). Women diagnosed with AKI were referred to specialists at level-2 hospital with intensive care and hemodialysis units. The study protocol was approved by national ethical committee. Clinical and biological data were collected during PNC visits and peripartum period. Primary outcome was all-cause maternal mortality and secondary outcomes were need for renal replacement therapy (RRT) and rate of renal recovery. Data were analyzed on an intention-to-treat basis. An independent t-test, Chi-square or Fisher’s exact tests were applied to compare mean or proportions between intervention and control groups. Study outcomes were analyzed using Cox-regression models.

RESULTS: Cumulative incidence of PR-AKI was 4.87% and 3.95% respectively in intervention and control health districts (p=0.03). Women followed-up in the intervention districts presented a higher adherence to PNC visits and earlier AKI diagnosis. Moreover, women with AKI in these districts showed lower need for RRT (24.6% vs 67.6%; p= 0.01), higher rate of renal function recovery (83.5% vs 48.6%, p=0.02) and lower mortality (2.2% vs 4.5%; HR: 0.52; [95% CI: 0.33-0.71]).

CONCLUSIONS: Integrating basic kidney screening during prenatal care visits can help reducing PR-AKI mortality and need for RRT in resource-limited settings.