Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study

Ravindra L Mehta; Emmanuel A Burdmann; Jorge Cerdá; John Feehally; Fredric Finkelstein; Guillermo García-García; Melanie Godin; Vivekanand Jha; Norbert H Lameire; Nathan W Levin; Andrew Lewington; Raúl Lombardi; Etienne Macedo; Michael Rocco; Eliah Aronoff-Spencer; Marcello Tonelli; Jing Zhang; Giuseppe Remuzzi

doi:10.1016/S0140-6736(16)30240-9

Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study

Lancet. 2016 May 14;387(10032):2017-25. doi: 10.1016/S0140-6736(16)30240-9. Epub 2016 Apr 13.

Authors

Ravindra L Mehta¹, Emmanuel A Burdmann², Jorge Cerdá³, John Feehally⁴, Fredric Finkelstein⁵, Guillermo García-García⁶, Melanie Godin⁷, Vivekanand Jha⁸, Norbert H Lameire⁹, Nathan W Levin¹⁰, Andrew Lewington¹¹, Raúl Lombardi¹², Etienne Macedo², Michael Rocco¹³, Eliah Aronoff-Spencer¹⁴, Marcello Tonelli¹⁵, Jing Zhang¹⁴, Giuseppe Remuzzi¹⁶

Affiliations

¹ Department of Medicine, University of California San Diego, San Diego, CA, USA. Electronic address: rmehta@ucsd.edu.
² LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
³ Division of Nephrology, Department of Medicine, Albany Medical College, Albany, NY, USA.
⁴ Renal Medicine, University of Leicester, Leicester, UK.
⁵ Yale University, New Haven, CT, USA.
⁶ Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico.
⁷ Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
⁸ The George Institute for Global Health India, University of Oxford, Oxford, UK.
⁹ Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium.
¹⁰ Mount Sinai School of Medicine, Renal Research Institute, New York, NY, USA.
¹¹ Department of Nephrology, Leeds Teaching Hospitals, Leeds, UK.
¹² Department of Critical Care Medicine, Servicio Médico Integral, Montevideo, Uruguay.
¹³ Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹⁴ Department of Medicine, University of California San Diego, San Diego, CA, USA.
¹⁵ University of Calgary, Calgary, AB, Canada.
¹⁶ IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.

PMID: 27086173
DOI: 10.1016/S0140-6736(16)30240-9

Abstract

Background: Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional differences in acute kidney injury recognition, management, and outcomes.

Methods: In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confirmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classified countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person.

Findings: Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p=0.33; p<0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549).

Interpretation: We identified common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community health-care settings, especially in LICs.

Funding: International Society of Nephrology.

Publication types

Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury / etiology
Acute Kidney Injury / mortality
Acute Kidney Injury / therapy*
Adult
Aged
Cross-Sectional Studies
Female
Global Health
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Prospective Studies
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding