World Incidence of AKI

Abstract

SummaryBackground and objectives The burden of AKI around the globe has not been systematically examined.Design, setting, participants, & measurements A systematic review (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) of large cohort studies was conducted to estimate the world incidence of AKI and its stages of severity and associated mortality, and to describe geographic variations according to countries, regions, and their economies. AKI definitions were reclassified according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system. Randomeffects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity.Results There were 312 studies identified (n=49,147,878) , primarily in hospital settings. Most studies originated from North America, Northern Europe, and Eastern Asia, from high-income countries, and from nations that spent $5% of the gross domestic product on total health expenditure. Among the 154 studies (n=3,585,911) that adopted a KDIGO-equivalent AKI definition, the pooled incidence rates of AKI were 21.6% in adults (95% confidence interval [95% CI], 19.3 to 24.1) and 33.7% in children (95% CI, 26.9 to 41.3). The pooled AKI-associated mortality rates were 23.9% in adults (95% CI, 22.1 to 25.7) and 13.8% in children (95% CI, 8.8 to 21.0). The AKIassociated mortality rate declined over time, and was inversely related to income of countries and percentage of gross domestic product spent on total health expenditure.Conclusions Using the KDIGO definition, 1 in 5 adults and 1 in 3 children worldwide experience AKI during a hospital episode of care. This analysis provides a platform to raise awareness of AKI with the public, government officials, and health care professionals.

Anemia Is a Risk Factor for Acute Kidney Injury and Long-Term Mortality in Critically Ill Patients

“…As a pathologic response, the anemia directly reduces the delivery of oxygen. Because AKI frequently develops in the ischemic conditions, anemia can be one of reasons for the high incidence of AKI in hospital-admitted patients (i.e., 1 in 5 adults and 1 in 3 children patients) (Susantitaphong et al 2013). Previous studies in several clinical settings (Karkouti et al 2009;Legrand et al 2013;Sickeler et al 2014) and our ICU results support the relationship between anemia and AKI.…”

Measuring acute kidney injury around the world: are we using the right thermometer (and adequately)?

“…None of the centers was in a low-income country, only 8.9 % of the patients came from lower-middle-income countries, and only 5.9 % were treated in countries where less than 5 % of the GDP is spent on health care. These results are in line with a recent systematic review evaluating the world incidence of AKI [2]. In this systematic review, among the 3.6 million patients evaluated in 154 studies, the vast majority of the studies (130; 84.4 %) accounting for 3.3 million patients came from high-income countries and only two studies (2227 patients) originated from low-or low-middle-income countries [2].…”

“…In this systematic review, among the 3.6 million patients evaluated in 154 studies, the vast majority of the studies (130; 84.4 %) accounting for 3.3 million patients came from high-income countries and only two studies (2227 patients) originated from low-or low-middle-income countries [2]. Unlike Hoste et al, this study found mortality to be inversely correlated with proportion of GDP spent at health care and with the country gross national income per capita [2]. This discrepancy may have several explanations.…”

Extended daily dialysis versus intermittent hemodialysis for acute kidney injury: A systematic review

“…Acute kidney injury (AKI) occurs frequently during hospitalization [1] and is associated with deleterious effects [2,3]. The need for renal replacement therapy (RRT) in AKI is rising [4] and continuous RRT (CRRT), extended daily dialysis (EDD) and intermittent hemodialysis (IHD) are the most commonly used techniques in developed countries.…”