Acute Kidney Injury Risk Assessment: Differences and Similarities Between Resource-Limited and Resource-Rich Countries

Abstract

The incidence of acute kidney injury (AKI) among acutely ill patients is reportedly very high and has vexing consequences on patient outcomes and health care systems. The risks and impact of AKI differ between developed and developing countries. Among developing countries, AKI occurs in young individuals with no or limited comorbidities, and is usually due to environmental causes, including infectious diseases. Although several risk factors have been identified for AKI in different settings, there is limited information on how risk assessment can be used at population and patient levels to improve care in patients with AKI, particularly in developing countries where significant health disparities may exist. The Acute Disease Quality Initiative consensus conference work group addressed the issue of identifying risk factors for AKI and provided recommendations for developing individualized risk stratification strategies to improve care. We proposed a 5-dimension, evidence-based categorization of AKI risk that allows clinicians and investigators to study, define, and implement individualized risk assessment tools for the region or country where they practice. These dimensions include environmental, socioeconomic and cultural factors, processes of care, exposures, and the inherent risks of AKI. We provide examples of these risks and describe approaches for risk assessments in the developing world. We anticipate that these recommendations will be useful for health care providers to plan and execute interventions to limit the impact of AKI on society and each individual patient. Using a modified Delphi process, this group reached consensus regarding several aspects of AKI risk stratification.

EPILAT-IRA Study: A contribution to the understanding of the epidemiology of acute kidney injury in Latin America

“…These features that mimic AKI from developed world, reflect a high proportion of patients coming from large urban tertiary hospitals, composing the “double epidemiological profile” of AKI in developing world. In this region coexists the typical young and previously healthy patient with AKI related to environmental and socioeconomically conditions, with the old and previously ill patient with AKI mostly acquired in the hospital [18]. In the majority of our cases, AKI was acquired in the community (62%) with late consultation entailing the loss of a window of opportunity for the prevention or mitigation of AKI.…”

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

“…While our understanding of pathogenic mechanisms is improving, we have to acknowledge that our knowledge of the incidence of these complications of the hypertensive disorders of pregnancy is still severely limited, in particular in middle- and low-income countries, a gap which is all the more important, given the estimation of a higher incidence of both AKI and the hypertensive disorders of pregnancy in these settings [ 54 , 55 ].…”

Recent Pattern of Acute Kidney Injury in Bosnia and Herzegovina

“…Analysis of factors that may have contributed to AKI drew our attention to surprisingly small number of patients diagnosed with sepsis (28,57%). According to the literature data, sepsis is one of the leading causes of AKI and multi organ failure, with evident rise in incidence rates, but sources for these data are mainly from HICs (2, 4, 6, 7, 9, 22-25). Data from LMICs are missing, incomplete or showing significantly lower incidence compared to HICs (6, 7, 9, 26).…”