Acute Kidney Injury Recognition in Low- and Middle-Income Countries

Cerdá, Jorge; Mohan, Sumit; Garcia-Garcia, Guillermo; Jha, Vivekanand; Samavedam, Srinivas; Gowrishankar, Swarnalata; Bagga, Arvind; Chakravarthi, Rajasekara; Mehta, Ravindra L.

doi:10.1016/j.ekir.2017.04.009

Cited by 46 publications

(39 citation statements)

References 173 publications

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“…Community-acquired AKI was defined as an episode of AKI when the initial event occurred outside of the hospital setting and the patient was subsequently admitted to the hospital with a diagnosis of AKI. Hospital acquired AKI was defined as an episode of AKI due to a kidney insult that occurred in hospitalized patients who developed de novo AKI during their hospital stay [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

et al. 2018

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BackgroundIn low and middle-income countries, reliable data on the epidemiology of childhood acute kidney injury (AKI) is lacking. The Global Snapshot, conducted by the ISN “0by25” AKI initiative, was a world-wide cross-sectional, observational study to evaluate AKI in hospitalized patients. Here we report the pediatric results of this study.Patients and methodsWe prospectively collected data on children who met the Kidney Disease Improving Global Outcomes AKI criteria during a 10-week window in late 2014. AKI risk factors, etiological factors, management and outcomes were recorded using standardized forms and protocols. Countries were classified according to their 2014 gross national income (GNI) per person into high-income countries (HIC), upper-middle income countries (UMIC) and low and low-middle income countries (LLMIC). Need for renal replacement therapy, mortality, and renal recovery were assessed 7 days after AKI diagnosis or at hospital discharge, whichever came first.Results92 centers from 41 countries collected data on 354 pediatric AKI patients; 53% of the children developed AKI while hospitalized and 47% in the community. The most common etiological factors for AKI differed across GNI categories as well as between patients with community-acquired vs. hospital-acquired AKI. Children from HIC were younger, and larger proportion of AKI in this group were due to post-surgical complications vs. other etiologies when compared to other income categories. In patients with hypotension as the cause of AKI, the adjusted risk of death was almost 10-fold higher compared to patients without hypotension as an etiological factor for AKI development. Mortality was similar within AKI stages in HIC and UMIC. In LLMIC, patients with the highest AKI level of severity had higher mortality than patients in higher income categories. Patients from LLMIC and UMIC had a 57-fold and 11 fold higher adjusted risk of death, respectively, compared to patients from HIC.ConclusionIn resource-limited countries, pediatric AKI-associated mortality is disproportionately higher when compared to high-resource areas, especially among patients with more severe AKI.

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Section: Methodsmentioning

confidence: 99%

Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

et al. 2018

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“…While our understanding of pathogenic mechanisms is improving, we have to acknowledge that our knowledge of the incidence of these complications of the hypertensive disorders of pregnancy is still severely limited, in particular in middle- and low-income countries, a gap which is all the more important, given the estimation of a higher incidence of both AKI and the hypertensive disorders of pregnancy in these settings [ 54 , 55 ].…”

Section: The Risk Of Aki In the Hypertensive Disorders Of Pregnancmentioning

confidence: 99%

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy-related acute kidney injury (pAKI), preeclampsia (PE), and the hypertensive disorders of pregnancy are closely related conditions, which are, in turn, frequently linked to pre-existing and often non-diagnosed chronic kidney disease (CKD). The current literature and research mainly underline the effects of pregnancy complications on the offspring; this review strongly emphasizes the maternal health as well. These conditions not only negatively affect pregnancy outcomes, but have a relevant effect on the future health of affected mothers and their children. Therefore, dedicated diagnostic and follow-up programs are needed, for optimizing materno-foetal health and reducing the impact of pregnancy-related problems in the mothers and in the new generations. This narrative review, performed on the occasion of the 2018 World Kidney Day dedicated to women’s health, focuses on three aspects of the problem. Firstly, the risk of AKI in the hypertensive disorders of pregnancy (the risk is the highest in developing countries; however PE is the main cause of pregnancy related AKI worldwide). Secondly, the effect of AKI and the hypertensive disorders of pregnancy on the development of CKD in the mother and offspring: long-term risks are increased; the entity and the trajectories are still unknown. Thirdly, the role of CKD in the pathogenesis of AKI and the hypertensive disorders of pregnancy: CKD is a major risk factor and the most important element in the differential diagnosis; pregnancy is a precious occasion for early diagnosis of CKD. Higher awareness on the importance of AKI in pregnancy is needed to improve short and long term outcomes in mothers and children.

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“…Early recognition of AKI is an essential step in allowing timely treatment in efforts to improve patient outcomes from this potentially reversible condition. 9 Diagnosis of AKI is highly dependent on the measurement of serum creatinine (SCr), which is almost universally available in high-income countries; however it is often not available in less privileged health care settings. In sub-Saharan Africa, obstetric patients are managed largely in district hospitals and community health centers, where SCr tests are unavailable, creating a significant barrier to the management of AKI.…”

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confidence: 99%

A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi

Evans

Cooke

Hemmilä

et al. 2018

Kidney International Reports

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IntroductionObstetric-related acute kidney injury (AKI) is associated with adverse outcomes for mother and fetus, particularly in low-income countries. However, laboratory-independent tools to facilitate diagnosis are lacking. We assessed the diagnostic performance of a salivary urea nitrogen (SUN) dipstick to detect obstetric-related acute kidney disease in Malawi.MethodsWomen at high risk for AKI admitted to an obstetric unit in Blantyre, Malawi, were recruited between 21 September and 11 December 2015. Patients underwent serum creatinine (SCr) testing alongside measurement of SUN using a dipstick on admission, and every 48 hours thereafter if evidence of kidney disease was found.ResultsA total of 301 patients were included (mean age 25.9 years, 11% HIV positive). Of the patients, 23 (7.6%) had AKI, stage 1 in 47.8%, most commonly due to preeclampsia/eclampsia. Mean presenting SCr values were 108.8 ± 21.8 μmol/l (1.23 ± 0.25 mg/dl), 118 ± 34.45 μmol/l (1.33 ± 0.39 mg/dl), and 136.1 ± 30.4 μmol/l (1.54 ± 0.34 mg/dl) in AKI stages 1 to 3 respectively. SUN > 14 mg/dl had a sensitivity of 12.82% and a specificity of 97.33% to detect acute kidney disease; the area under the receiver operating characteristic curve was 0.551. In patients with normal SUN on admission, perinatal mortality was 11.8%, and was 25.0% if SUN was > 14 mg/dl (P = 0.18).ConclusionThe SUN dipstick was specific but insensitive when used to diagnose obstetric-related AKI. Limited biochemical derangement and low salivary urea concentrations due to physiological changes in pregnancy, as opposed to a technical limitation of the dipstick itself, are the likely reason for the lack of sensitivity in this study.

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Acute Kidney Injury Recognition in Low- and Middle-Income Countries

Cited by 46 publications

References 173 publications

Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi

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