Assessment of point-of-care creatinine testing in pregnancy: a prospective cohort study in Sierra Leone

Background Pregnancy-associated acute kidney injury (PrAKI) is a major contributor to maternal and perinatal morbidity and mortality in low-and middle-income countries, where detection is often delayed due to limited access to creatinine testing. Point-of-care creatinine (POC-Cr) devices may offer a practical alternative. We aimed to describe the incidence, resolution, and clinical consequences of presumed PrAKI or kidney dysfunction among high-risk pregnant and postpartum women, and to assess feasibility of POC-Cr testing. Methods We conducted a study of pregnant or postpartum women at high risk of PrAKI at a hospital in Freetown, Sierra Leone (April–August 2023). Eligibility criteria were systolic blood pressure ≥140 mmHg, diastolic ≥90 mmHg, and/or shock index ≥0.9. Women underwent POC-Cr testing at enrolment and 24 and 48 h. PrAKI was defined as POC-Cr >77 μmol/L, or a change ≥26 μmol/L, and staged where possible. Associations with maternal and perinatal outcomes were assessed. Multivariable logistic regression identified risk factors. Feasibility was evaluated by refusal and test failure. Findings Of 1746 eligible women, 1669 (96%) were tested; two declined and one failed. PrAKI or chronic kidney disease occurred in 427 (25.6%). Affected women had maternal (15.4%, 66/427 versus 8.7%, 108/1239) and perinatal (19.3%, 23/119 versus 4.8%, 20/413) adverse outcomes ( p < 0.0001). At discharge, 47%, 202/427 had unresolved kidney injury or underlying disease. Independent risk factors included age, mean arterial pressure, and pre-eclampsia or eclampsia. Interpretation Kidney dysfunction complicates a quarter of pregnancies and is associated with adverse outcomes. POC-Cr testing may enable earlier detection and improved care in resource-limited settings. Funding This study was funded by the UK Medical Research Council (MR/T038594/1) and the National Institute for Health and Care Research (NIHR133232).