The contrasting characteristics of acute kidney injury in developed and developing countries

Abstract

Acute kidney injury (AKI) has become increasingly prevalent in both developed and developing countries, and is associated with severe morbidity and mortality, especially in children. Uncertainty regarding the true incidence of AKI limits awareness of the problem, thereby reducing political visibility of the disorder and hampering efforts to prevent its occurrence. In developed countries, AKI occurs predominantly in urban intensive care units and is associated with multiorgan failure and sepsis, high mortality, and occurrence in older populations. While cases of AKI in urban areas of the developing world have similar characteristics to those in the developed world, AKI in rural regions commonly develops in response to a single disease and specific conditions (e.g. gastroenteritis) or infections (e.g. severe malaria, leptospirosis, or hemolytic-uremic syndrome) and in younger otherwise healthy individuals. Many causes of AKI in rural settings, such as diarrhea, poisoning, malaria, or septic abortion, can be prevented by interventions at the individual, community, and regional levels. Treatment with dialysis is often unavailable or too costly in developing regions, so there must be community-wide efforts to eradicate causes of AKI, expedite diagnosis, and aggressively manage prerenal conditions and specific infections. We have reviewed recent literature on AKI, identified differences and similarities in the condition between developed and developing areas, analyzed the practical implications of the identified differences, and made evidence-based recommendations for study and management.

Antioxidant and Nephroprotective Activities of Aconitum heterophyllum Root in Glycerol Induced Acute Renal Failure in Rats

“…Cerdá J stated that AKI takes place predominantly in urban intensive care units and is associated with multiorgan failure and sepsis, high mortality and occurrence in older populations [38]. The world-wide socioeconomic impact of AKI and it is due to the lack of specific treatments; necessitate major efforts to identify novel and effective therapeutic strategies.…”

The Nexus of Acute Kidney Injury, Chronic Kidney Disease, and World Kidney Day 2009

“…A recent review of the world literature on AKI outlines potential similarities and differences among developed and developing countries (6). While community-acquired AKI occurs with variable frequency in developed countries, AKI is more consistently caused by community-acquired diseases in developing countries.…”

Use of Peritoneal Dialysis in AKI

“…Contributing factors include the development of efficient and easy-to-place central venous catheters, the expanded use of CRRTs and slow extended daily dialysis in affluent countries, and the perception that PD offers inferior care. Also, the etiology of AKI varies in developed and emerging economies (40). AKI treated in Western countries is often in the setting of hypercatabolic multiorgan failure in the ICU in elderly patients with multiple comorbidities.…”