EPILAT-IRA Study: A contribution to the understanding of the epidemiology of acute kidney injury in Latin America

Abstract

IntroductionEpidemiology of acute kidney injury (AKI) is highly dependent on patient characteristics, context and geography. Considering the limited information in Latin America and the Caribbean, we performed a study with the aim to contribute to improve its better understanding.MethodsObservational, prospective, longitudinal, multinational cohort study addressed to determine risk factors, clinical profile, process of care and outcomes of AKI in the region. Patients meeting KDIGO AKI definition were included over a 9-month period and designated community or hospital-acquired. De-identified clinical and lab data were entered in a specifically designed on-line platform. Co-variables potentially linked to AKI onset, in-hospital and 90-days mortality, were recorded and correlated using a multiple logistic regression model.ResultsFifty-seven physicians from 15 countries provided data on 905 patients, most with acceptable basic needs coverage. Median age 64 (50–74) yrs; most of them were male (61%) and mestizos (42%). Comorbidities were present in 77%. AKI was community-acquired in 62%. Dehydration, shock and nephrotoxic drugs were the commonest causes. During their process of care, 77% of patients were assessed by nephrologists. Kidney replacement therapy (KRT) was performed in 29% of cases. In-hospital mortality was 26.5% and independently associated to older age, chronic liver disease, hypotension, shock, cardiac disturbances, hospital-acquired sepsis, KRT and mechanical ventilation. At 90-days follow up partial or complete renal recovery was 81% and mortality 24%.ConclusionsAKI was mainly community-acquired, in patients with comorbidities and linked to fluid loss and nephrotoxic drugs. Mortality was high and long-term follow up poor. Notwithstanding, the study shows partially the situation in the participant countries rather than the actual epidemiology of AKI in Latin America and Caribbean, a pending and needed task.

Acute renal failure in children. Multicenter prospective cohort study in medium-complexity intensive care units from the Colombian southeast

“…Pediatric patients with AKI reach their maximum KDIGO stage during the first week after diagnosis [9,16,25,26]. In our study, most of the patients included reached their maximum KDIGO stage on day one after admission to PICU and this may be explained by several potential factors: patients included came from rural areas, had varying degrees of malnutrition, and presented insurance-related barriers to health care in agreement with previous recent reports from Latin America [21].…”

“…In a recent survey carried out by SLANH in Latin America, hemodialysis was the main approach to RRT and its selection was guided mainly by economic and organizational regional reasons [21]. However, there would be strong variation among and within countries.…”

“…By using the KDIGO classification, the authors reported factors, such as dehydration, presence of shock, and use of nephrotoxic drugs as the most common potential causes of AKI. Mortality rate has been related with shock status, major cardiac abnormalities, presence of sepsis, use of renal replacement therapy (RRT), and use of mechanical ventilation [21].…”

Renal Replacement Therapy for Acute Kidney Injury in COVID-19 Patients in Latin America

“…Several patients received more than one type of RRT. Reasons for initiation of RRT were electrolyte and/or acid base disturbances (70%), fluid overload (54%), and solute control (48%) [6].…”

Acute kidney injury requiring renal replacement therapy during the COVID-19 pandemic: what are our options for treating it in Latin America?

“…AKI was community-acquired in 62% of patients, with dehydration, shock and nephrotoxic drugs being the most common causes. Renal replacement therapy (RRT) was performed in 29% of cases, and the incidence of all-cause in-hospital mortality was 26.5%( 3 ). Preliminary and unpublished data from the Latin American Society of Nephrology and Hypertension (SLANH) AKI Committee registry of AKI in COVID-19 patients, which has enrolled 393 subjects so far, showed that more than 50% of patients were female, the median age was 60 (IQR 48-71), 36% of patients developed proteinuria and 17% presented with hematuria.…”