Acute Kidney Injury in Western Countries

Abstract

Background: Acute kidney injury (AKI) is frequent and is associated with poor outcomes, including increased mortality, higher risk of chronic kidney disease, and prolonged hospital lengths of stay. The epidemiology of AKI mainly derives from studies performed in Western high-income countries. More limited data are available from Western low-income and middle-income countries (LMICs) located in Central and South America. Summary: In this review, we summarize the most recent data on the epidemiology of AKI in Western countries, aiming to contrast results from industrialized high-income countries with LMICs. The global picture of AKI in LMICs is not as well characterized as in the USA and Europe. In addition, in some LMICs, the epidemiology of AKI may vary depending on the region and socioeconomic status, which contributes to the difficulty of getting a better portrait of the clinical condition. In low-income regions and tropical countries, AKI is frequently attributed to diarrhea, infections, nephrotoxins, as well as obstetric complications. As opposed to the situation in high-income countries, access to basic care in LMICs is limited by economic constraints, and treatment is often delayed due to late presentation and recognition of the condition, which contribute to worse outcomes. In addition, dialysis is often not available or must be paid by patients, which further restricts its use. Key Messages: There are great disparities in the epidemiology of AKI between Western high-income countries and Western LMICs. In LMICs, education and training programs should increase the public awareness of AKI and improve preventive and basic treatments to improve AKI outcomes. Facts from East and West: (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion ma...

The outcome of Acute Kidney Injury in patients with severe Malaria

“…We con irmed that the new KDIGO criteria show robust predictive abilities for disease severity and hospital outcomes in this large cohort of patients with malaria and AKI, as was similarly shown in recent studies in a variety of critically ill patients [16][17][18][19][20]. Upon hospital admission, no patients with AKI Stage 1 required for renal replacement therapy, while dialysis was required in 23% and 42% of the patients with AKI Stage 2 and 3, respectively.…”

Simplified prognostic model for critically ill patients in resource limited settings in South Asia

“…The variables included patient age, type of admission (elective surgery, emergency surgery, or medical) as per APACHE II coding [ 19 ], and admission clinical assessments of temperature, heart rate, fraction of inspired oxygen (FiO 2 ), respiratory rate, systolic blood pressure, peripheral oxygen saturation, and Glasgow Coma Scale (GCS). Laboratory variables included haemoglobin and blood urea which are increasingly available in LMICs [ 20 ]. Treatment measures included use of mechanical ventilation, vasopressors, and antibiotics administered at the time of or immediately following admission.…”

Plasma Concentrations of Extracellular DNA in Acute Kidney Injury

“…Surviving AKI is associated with declined quality of life, and it is currently considered the major risk factor for developing chronic kidney disease (CKD) [2]. Annual costs of management of AKI are estimated at USD 10 billion in the United States and USD 1.7 billion in the United Kingdom [5].…”