Exploring Pregnancy-Related Acute Kidney Injury: Risk Factors and Maternal Outcomes in High-Risk Women in Mwanza, Tanzania

Background/Objective: Pregnancy-related acute kidney injury (PRAKI) remains a serious complication, with high rates of maternal morbidity and mortality, particularly in developing countries where delayed diagnosis and treatment are common. This study aimed to determine the proportion, associated risk factors, and maternal outcomes among pregnant and postpartum women at high risk of developing AKI. Methods: This cross-sectional analytical study was conducted at Bugando Medical Centre in Mwanza, Tanzania, from May 2023 to February 2024, targeting high-risk obstetric patients. Results: Out of 4588 admissions, 420 patients were identified as being at risk of developing PRAKI. Among them, 101 (24.22%) were diagnosed with PRAKI, while 316 (75.78%) did not develop the condition. The leading associated risk factors were pre-eclampsia (40.59%) and postpartum hemorrhage (PPH) (40.24%), followed by sepsis (11.8%) and abortion-related complications (5.94%). Multivariate analysis revealed that living in rural areas and having a lower level of education were significantly associated with PRAKI. Patients from rural areas had an adjusted odds ratio (AOR) of 5.37 (p < 0.001), while those with informal or primary education had an AOR of 4.21 (p = 0.048). Conclusions: The study also found that maternal mortality was significantly higher among patients with PRAKI, particularly those affected by PPH. These findings highlight the urgent need for improved management of obstetric emergencies to reduce PRAKI incidence and improve maternal outcomes in high-risk populations.