@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 < 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},
  keywords     = {RENAL REPLACEMENT THERAPY,CRITICALLY-ILL PATIENTS,VOLUME,PERITONEAL-DIALYSIS,INTENSIVE-CARE,AKI,EPIDEMIOLOGY,FAILURE,HEMODIALYSIS,OUTCOMES},
  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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