Assessment of Point-of-care cReatinine testing In pregnancy: a feasibility COhort sTudy in Sierra Leone.
THE PROBLEM TO ADDRESS
Our previous work showed that 76% of maternal deaths in Sierra Leone are related to three causes – hypertensive disorders, haemorrhage and sepsis, all of which commonly lead to acute kidney injury (AKI). AKI in pregnancy is associated with high maternal and fetal mortality rates in low income countries (6 to 30%). In a large prospective observational study in South Africa, our group found that 15% (237/1547) of pregnant women admitted to hospital with hypertensive disorders had AKI. The relative risk of death in this group of women was 6.2 (95% CI 2.2 to 17) and only half had full renal recovery.
Resource limitations and lack of AKI awareness in Sierra Leone mean that it often goes undetected, which can be life-threatening, and increases risk of chronic kidney disease and pre-eclampsia complicating future pregnancies. Early detection and education to enable timely management has been demonstrated to reduce AKI associated complications. Point-of-care creatinine (POC-Cr) testing has been shown to improve outcomes, is cost effective, and easy to use in pregnant and non-pregnant patients, with results immediately available to enable prompt action.
Our main study objectives are to:
- Assess feasibility of POC-Cr testing in pregnant and postpartum women in Princess Christian Maternity Hospital.
- Compare accuracy and precision of POC-Cr and venous creatinine and establish whether an adjustment factor is required.
- Estimate the incidence of AKI at 24 hours post admission/ AKI associated event assessed by serum creatinine (KDIGO) criteria in pregnant and postpartum women.
- Determine threshold changes in POC-Cr which are predictive of AKI confirmed by serum creatinine concentration at 24 hours post admission/ AKI associated event
- Compare incidence of AKI at 24 hours post admission/ AKI associated event in women with and without serial POC-Cr testing pre and post staff training.
- Determine acceptability of POC-Cr amongst healthcare providers and women.