A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries

Abstract

Objectives Although the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence. Methods A systematic review of published studies reporting AKI in intensive care units (2005-2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model. Results Ninety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the metaanalysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries.

Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement Therapy During the COVID-19 Pandemic in the United States

“…For this simulated cohort, we determined the incidence of AKI 3D requiring CKRT, the time from hospitalization to the development of AKI 3D requiring CKRT, and the duration of CKRT from the published literature ( Table 1 ). 3 , 4 , 5 , 7 , 8 , 20 , 21 We estimated an incidence of AKI 3D requiring CKRT from the largest New York study of patients with COVID-19. 8 Within this study, 5.2% of hospitalized patients with COVID-19 developed AKI 3D in the ICU.…”

“…1,2 Among critically ill patients with COVID-19, 4.8% to 6.9% develop acute kidney injury stage 3 requiring dialysis (AKI 3D), a condition routinely managed with continuous kidney replacement therapy (CKRT) in the intensive care unit (ICU). [3][4][5][6][7][8][9] Anticipating this surge, health care systems underwent crisis capacity activation for inpatient kidney replacement therapy (KRT), constituting a substantial adjustment to standards of care. 4,7,10,11 Nephrologists used various strategies to improve KRT capacity, including procuring additional CKRT machines from manufacturers, decreasing the dose and duration of CKRT, and expanding the use of intermittent dialysis modalities such as hemodialysis (HD) and peritoneal dialysis (PD).…”

“…1 , 2 Among critically ill patients with COVID-19, 4.8% to 6.9% develop acute kidney injury stage 3 requiring dialysis (AKI 3D), a condition routinely managed with continuous kidney replacement therapy (CKRT) in the intensive care unit (ICU). 3 , 4 , 5 , 6 , 7 , 8 , 9 …”

Regional differences in Acute Kidney Injury incidence and mortality in developing countries: recent trends

“…It is well recognized that the burden of AKI is often underrepresented in the developing world and has prompted initiatives to improve awareness of AKI and develop strategies for its prevention and management 6 . Previous studies have shown different etiologies and outcomes following AKI in developed and developing countries based on governmental health service infrastructure and expenditures 7 . In a recent metanalysis, patients’ characteristics were mostly similar in high and low and low middle-income countries, but outcomes were worse for patients in developing countries 7 .…”

“…Previous studies have shown different etiologies and outcomes following AKI in developed and developing countries based on governmental health service infrastructure and expenditures 7 . In a recent metanalysis, patients’ characteristics were mostly similar in high and low and low middle-income countries, but outcomes were worse for patients in developing countries 7 . Nevertheless, very heterogeneous outcomes can be found within the same country as regional differences in the availability of health care resources and access to care influence patient management.…”