Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit

Daher, Elizabeth De Francesco; Silva, Geraldo Bezerra da; Vieira, Ana Patrícia Freitas; Souza, Juliana Bonfim de; Falcão, Felipe dos Santos; Costa, Cristiane Rocha da; Fernandes, Anna Allicy Câmara da Silva; Lima, Rafael Siqueira Athayde

doi:10.1590/0037-8682-0223-2013

Cited by 31 publications

(38 citation statements)

References 24 publications

(15 reference statements)

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“…Unlike other studies, we did not find that MV was associated with 90-day mortality,26 but was associated with persistent AKI. First, MV may affect the kidney by causing hemodynamic abnormalities and affecting renal perfusion by decreasing GFR by reducing cardiac output and stimulating hormonal and sympathetic pathways 27.…”

Section: Discussioncontrasting

confidence: 99%

The impact of transient and persistent acute kidney injury on short-term outcomes in very elderly patients

Li¹,

Zhao²,

Wang³

2017

CIA

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ObjectivesAcute kidney injury (AKI) is a common complication in elderly patients and is associated with poor outcomes. However, the effect of transient and persistent geriatric AKI on short-term mortality is unclear. We aimed to study the incidence, clinical characteristics, and prognostic impact of transient and persistent AKI in such patients.MethodsWe retrospectively enrolled very elderly patients (≥75 years) from the geriatric department of the Chinese PLA General Hospital between 2007 and 2015. AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. AKI patients were divided into transient or persistent AKI groups based on their renal function at 3 days post-AKI. Renal function recovery was defined as a return to the baseline serum creatinine (SCr) levels.ResultsIn total, 668 geriatric patients (39.0%) experienced AKI, and 652 satisfied the inclusion criteria. Of these 652 patients, 270 (41.4%) had transient AKI, and 382 (58.6%) had persistent AKI. The 90-day mortality was 5.9% in patients with transient AKI and 53.1% in patients with persistent AKI. Multivariate analysis revealed that low hemoglobin levels (odds ratio [OR] =0.989; 95% CI: 0.980–0.999; P=0.025), low mean aortic pressure (OR =0.985; 95% CI: 0.971–1.000; P=0.043), peak SCr (OR =1.020; 95% CI: 1.015–1.026; P<0.001) levels, high uric acid (OR =1.002; 95% CI: 1.000–1.003; P=0.040) levels, high blood urea nitrogen (OR =1.028; 95% CI: 1.000–1.056; P=0.047) levels, and mechanical ventilation requirements (OR =1.610; 95% CI: 1.012–2.562; P=0.044) were associated with persistent AKI. Persistent AKI (hazard ratio [HR] =5.741; 95% CI: 3.356–9.822; P<0.001) and more severe AKI stages (stage 2: HR =3.363; 95% CI: 1.973–5.732; P<0.001 and stage 3: HR =4.741; 95% CI: 2.807–8.008; P<0.001) were associated with 90-day mortality.ConclusionAKI is common in very elderly patients, with transient renal injury representing close to 42% of all cases of geriatric AKI. More frequent SCr measurements may be helpful for the early diagnosis of transient geriatric AKI. Persistent geriatric AKI is independently associated with a significantly higher risk of 90-day mortality.

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Section: Discussioncontrasting

confidence: 99%

The impact of transient and persistent acute kidney injury on short-term outcomes in very elderly patients

Li¹,

Zhao²,

Wang³

2017

CIA

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“…In tertiary hospitals in urban areas, causes are similar as in high-income countries [18] but may also include tropical infectious diseases such as malaria, leptospirosis, and dengue [19,20]. In rural areas, AKI is often attributed to diarrhea, tropical infectious diseases, animal venoms, natural medicines and dyes, and obstetric complications including septic abortion [1,21,22].…”

Section: Causes and Patterns Of Aki In Western Countriesmentioning

confidence: 99%

“…AKI is a serious complication of dengue, and its frequency is not well characterized but seems to occur in 1-13% of patients [28]. In a retrospective study from a tertiary infectious diseases hospital in Brazil, 4% of critically ill patients with AKI were affected by dengue [20]. Human immunodeficiency virus (30%), tuberculosis (12%), and leptospirosis (11%) occurred more frequently than dengue [20].…”

Section: Causes and Patterns Of Aki In Western Countriesmentioning

confidence: 99%

“…In a retrospective study from a tertiary infectious diseases hospital in Brazil, 4% of critically ill patients with AKI were affected by dengue [20]. Human immunodeficiency virus (30%), tuberculosis (12%), and leptospirosis (11%) occurred more frequently than dengue [20]. Treatment for dengue is mainly supportive, and although rhabdomyolysis is rarely associated with dengue, monitoring of serum creatine kinase levels is required to promptly diagnose and treat this condition which can further contribute to AKI.…”

Section: Causes and Patterns Of Aki In Western Countriesmentioning

confidence: 99%

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Acute Kidney Injury in Western Countries

Bouchard

Mehta

2016

Kidney Dis

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Background: Acute kidney injury (AKI) is frequent and is associated with poor outcomes, including increased mortality, higher risk of chronic kidney disease, and prolonged hospital lengths of stay. The epidemiology of AKI mainly derives from studies performed in Western high-income countries. More limited data are available from Western low-income and middle-income countries (LMICs) located in Central and South America. Summary: In this review, we summarize the most recent data on the epidemiology of AKI in Western countries, aiming to contrast results from industrialized high-income countries with LMICs. The global picture of AKI in LMICs is not as well characterized as in the USA and Europe. In addition, in some LMICs, the epidemiology of AKI may vary depending on the region and socioeconomic status, which contributes to the difficulty of getting a better portrait of the clinical condition. In low-income regions and tropical countries, AKI is frequently attributed to diarrhea, infections, nephrotoxins, as well as obstetric complications. As opposed to the situation in high-income countries, access to basic care in LMICs is limited by economic constraints, and treatment is often delayed due to late presentation and recognition of the condition, which contribute to worse outcomes. In addition, dialysis is often not available or must be paid by patients, which further restricts its use. Key Messages: There are great disparities in the epidemiology of AKI between Western high-income countries and Western LMICs. In LMICs, education and training programs should increase the public awareness of AKI and improve preventive and basic treatments to improve AKI outcomes. Facts from East and West: (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion ma...

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“…[17][18][19] However, several different exposures contributing to AKI in different settings are unknown or difficult to access, challenging the development of a unified tool for risk assessment ( Table 1). 12,[20][21][22][23][24][25][26] Nevertheless, individuals exposed to these insults must have a careful determination of overall risk of AKI, and, when possible, the exposure should be avoided.…”

Section: Strategies For Increasing Awareness and Reducing Variations mentioning

confidence: 99%

Preventing Acute Kidney Injury

Macedo

Mehta

2015

Critical Care Clinics

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Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit

Cited by 31 publications

References 24 publications

The impact of transient and persistent acute kidney injury on short-term outcomes in very elderly patients

The impact of transient and persistent acute kidney injury on short-term outcomes in very elderly patients

Acute Kidney Injury in Western Countries

Preventing Acute Kidney Injury

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