A – Organic Acute renal failure

A – Acute tubular necrosis

World Incidence of AKI: A Meta-Analysis

Paweena Susantitaphong*, †‡Dinna N. Cruz§, Jorge Cerda‖, Maher Abulfaraj*, Fahad Alqahtani*, Ioannis Koulouridis*,†, Bertrand L. Jaber*,† for the Acute Kidney Injury Advisory Group of the American Society of Nephrology

Clinical Journal of the American Society of Nephrology

Correspondence:
Dr. Bertrand L. Jaber, Kidney and Dialysis Research Laboratory, Division of Nephrology, Department of Medicine, St. Elizabeth’s Medical Center, 736 Cambridge Street, Boston, MA 02135. Email

ABSTARCT

Background and objectives

The burden of AKI around the globe has not been systematically examined.

Design, setting, participants, & measurements

A systematic review (2004–2012) 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. Random-effects 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 AKI-associated 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.

COMMENTS

The study, based on a robust statistical analysis background gathers worlwide material classified using the KDIGO or KDIGO-equivalent serum creatinine-based Acute Kidney Insufficiency definition and staging system or dialysis requirement. AKI-associated mortality rate is depicted on the following slide.

There is a need for greater innovation in the prevention and treatment of AKI, a condition that affects 1 in 5 hospitalized patients worldwide. As World Kidney Day 2013 focuses on AKI, this analysis provides a platform to facilitate discussions among health care professionals, the public, and policy makers to raise awareness about AKI and its associated health care burden. These discussions should encourage providers to design better hospital-based health care delivery systems that focus on the prevention, early detection, and treatment of AKI, improve patient safety, and ultimately, preserve kidney health and well-being while mitigating the long-term costly burden of CKD.

Pr. Jacques CHANARD

ProfessorofNephrology