The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study

Abstract

Background Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand. Methods We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI. Results We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development. Conclusions In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.

Incidence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

“…A recent study conducted by Srisawat, et al reported that the incidence of AKI stage 3 among patients in ICU was 28.9%; 16.4% of the patients at ICU had AKI stage 2 and 7.5% had AKI stage 1. 11 Aside from that, they also showed that when the patients were admitted to ICU, most of the AKI patients progressed to AKI stage 3. This can be explained that AKI was not recognized in time so was not treated appropriately by the time the patients were admitted to the ICU.…”

“…Informed consent was waived. This study is part of the Southeast Asia-Acute Kidney Injury (SEA-AKI) study that has been previously described by Srisawat et al 6 Demographic and clinical data from all of the participants were collected such as admission date, sex, age, body mass index (BMI), primary diagnosis at ICU admission, history of comorbid conditions, AKI stages, RRT modes, and the use of mechanical ventilation during ICU stay. The severity of participants was determined by the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scoring system.…”

SEA-MAKE score as a tool for predicting major adverse kidney events in critically ill patients with acute kidney injury: results from the SEA-AKI study

“…We also found that predictive ability of SEA-MAKE score was higher in university and regional hospitals than provincial hospitals (Additional file 1: Table S4). Formal sample size calculation was not calculated in our study because it was fixed to the Southeast Asia AKI study [10]. All available data of the cohort were used to maximize the power and generalizability.…”

“…Only data from the first admission were used if the patients have been admitted to the hospital several times during the study period. Formal sample size was not calculated because it was fixed to the Southeast Asia AKI cohort [10]. All available data were used to maximize the power and generalizability of the proposed model.…”

The diagnostic value of combined indexes in Acute Renal injury after Cardiopulmonary Bypass Surgery in infants with Congenital Heart Disease

“…According to research, the Rate of AKI in community hospitals is about 2%, while in large academic institutions, the rate of AKI accounts for more than 20% of all hospitalisations [9,10]. In addition, if specific hospital units are studied such as ICU, cardiac surgery,and transplant centers, the rate of AKI can be 50% or more [11,12] .…”