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

(2016) LANCET. 387(10032). p.2017-2025
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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 healthcare settings, especially in LICs.
Keywords
RENAL REPLACEMENT THERAPY, CRITICALLY-ILL PATIENTS, VOLUME, PERITONEAL-DIALYSIS, INTENSIVE-CARE, AKI, EPIDEMIOLOGY, FAILURE, HEMODIALYSIS, OUTCOMES

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Citation

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Chicago
Mehta, Ravindra L, Emmanuel A. Burdmann, Jorge Cerda, John Feehally, Fredric Finkelstein, Guillermo Garcia-Garcia, Melanie Godin, et al. 2016. “Recognition and Management of Acute Kidney Injury in the International Society of Nephrology 0by25 Global Snapshot : a Multinational Cross-sectional Study.” Lancet 387 (10032): 2017–2025.
APA
Mehta, R. L., Burdmann, E. A., Cerda, J., Feehally, J., Finkelstein, F., Garcia-Garcia, G., Godin, M., et al. (2016). Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot : a multinational cross-sectional study. LANCET, 387(10032), 2017–2025.
Vancouver
1.
Mehta RL, Burdmann EA, Cerda J, Feehally J, Finkelstein F, Garcia-Garcia G, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot : a multinational cross-sectional study. LANCET. 2016;387(10032):2017–25.
MLA
Mehta, Ravindra L, Emmanuel A. Burdmann, Jorge Cerda, et al. “Recognition and Management of Acute Kidney Injury in the International Society of Nephrology 0by25 Global Snapshot : a Multinational Cross-sectional Study.” LANCET 387.10032 (2016): 2017–2025. Print.
@article{8532549,
  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 {\textlangle} 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 healthcare settings, especially in LICs.},
  author       = {Mehta, Ravindra L and Burdmann, Emmanuel A. and Cerda, Jorge and Feehally, John and Finkelstein, Fredric and Garcia-Garcia, Guillermo and Godin, Melanie and Jha, Vivekanand and Lameire, Norbert and Levin, Nathan W and Lewington, Andrew and Lombardi, Raul and Macedo, Etienne and Rocco, Michael and Aronoff-Spencer, Eliah and Tonelli, Marcello and Zhang, Jing and Remuzzi, Giuseppe},
  issn         = {0140-6736},
  journal      = {LANCET},
  language     = {eng},
  number       = {10032},
  pages        = {2017--2025},
  title        = {Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot : a multinational cross-sectional study},
  url          = {http://dx.doi.org/10.1016/S0140-6736(16)30240-9},
  volume       = {387},
  year         = {2016},
}

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