World Incidence of AKI: A Meta-Analysis : Clinical Journal of the American Society of Nephrology (original) (raw)

Original Articles

World Incidence of AKI

A Meta-Analysis

Susantitaphong, Paweena*,†,‡; Cruz, Dinna N.§; Cerda, Jorge‖; Abulfaraj, Maher*; Alqahtani, Fahad*; Koulouridis, Ioannis*,†; Jaber, Bertrand L.*,†

*Kidney and Dialysis Research Laboratory, Division of Nephrology, Department of Medicine, St. Elizabeth’s Medical Center, Boston, Massachusetts;

†Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts;

‡Extracorporeal Multiorgan Support Dialysis Center, Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

§Division of Nephrology, University of San Diego, San Diego, California; and

‖Albany Medical College, Albany, New York

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 [email protected]

Received January 21, 2013

Accepted April 19, 2013

Online date: June 06, 2013

Abstract

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.