Disparities in pregnancy-related AKI may be linked to socioeconomic factors, lack of quality health care

Kelly Beers

BOSTON — Disparities in which women are more likely to develop pregnancy-related AKI, often thought of in terms of genetics and race, may instead be primarily due to socioeconomic factors that result in unequal access to health care, according to a poster presented at the National Kidney Foundation Spring Clinical Meetings.

“Overall, it’s well known that there are racial disparities in pregnancy but there has never to date been a study looking at racial disparities in kidney disease in pregnancy, which is what we wanted to address,” Kelly Beers, MD, of the division of nephrology in the department of medicine at Icahn School of Medicine, Mount Sinai, New York, told Healio/Nephrology. “What we ultimately found was there are, in fact, significant racial disparities; but what’s interesting is that when we adjust for clinical morbidities and socioeconomic status, a lot of those disparities go away. This raises the concern that a lot of the disparities we’re seeing with general pregnancy outcomes, as well as in kidney disease, are probably being driven by social determinants of health.”

To examine the trends in pregnancy-related AKI, researchers used a nationally representative dataset regarding hospitalized pregnant women from 2005 to 2013.

Researchers found pregnant women who were hospitalized with AKI had more comorbidities, including diabetes (14% vs. 1.3%) and hypertension (28% vs. 2.3%) than women without AKI.

Regarding racial disparities, researchers found patients with AKI were more likely to be African American or Hispanic. It was also determined that Hispanic participants (aOR = 1.41) had greater odds of preterm labor than white participants (aOR = 1.3), as well as greater odds of preeclampsia (aOR = 1.33) and greater rates of being discharged home (aOR = 1.43).

Furthermore, researchers noted that although rates of pregnancy-related AKI increased in all race/ethnic groups, African American participants had the greatest rates and the largest increase.

What surprised researchers about the results, according to Beers, was that the differences in outcomes were attenuated once they adjusted for clinical morbidities and socioeconomic status.

“I fully expected that, given how much more kidney disease you see in African Americans in pregnancy, there would be a genetic reason for that,” she said. However, as this was not the case, “we strongly suspect that socioeconomic factors are playing a big part here.”

Beers noted that a limitation of the trial was that researchers only examined data from hospital admissions, and so they are uncertain as to the quality of prenatal care the women received. Despite this lack of data, Beers said there was a strong chance that many of the women who had poorer outcomes “just didn’t have good prenatal care, which is something that definitely needs to be addressed.”

In clinical practice, Beers said that health care providers need to be aware of these socioeconomic disparities to do a better job of taking care of all patients. She would also like to see greater access to health care for low-income patients of any race.

“I think you can see across medicine that there’s a huge disparity in America between people who have easy access to health care and those who don’t,” she concluded. “We have [to recognize] that if we offer good strong medical care to all patients, they’re going to do better.” – by Melissa J. Webb

Reference:

Beers K, et al. Racial disparities in pregnancy-related acute kidney injury. Presented at: National Kidney Foundation Spring Clinical Meetings; May 8-12, 2019; Boston.

Disclosure: Beers reports no relevant financial disclosures.