Changing epidemiology of community-acquired acute kidney injury in developing countries: analysis of 2405 cases in 26 years from eastern India

Abstract

BackgroundThe epidemiology of acute kidney injury (AKI) differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India.MethodsThis study aimed at describing changes in epidemiology of community-acquired AKI (CAAKI) over a time span of 26 years in two study periods, namely, 1983–95 and 1996–2008.ResultsWe studied 2405 (1375 male and 1030 female) cases of AKI in the age range 1–95 (mean: 40.32) years. The incidence of CAAKI in 1983–95 and 1996–2008 was 1.95 and 4.14 per 1000 admission, respectively (P < 0.01). Obstetrical AKI has decreased because of the declining number of post-abortal AKI. Surgical AKI decreased from 13.8% in 1983–95 to 9.17% in 1996–2008(P < 0.01). Malarial AKI increased significantly from 4.7% in the first half of the study to 17% in the later period (P < 0.01). Diarrhea-associated AKI had significantly decreased from 36.83% in 1983–95 to 19% in 1996–2008 (P < 0.01). Sepsis-related AKI had increased from 1.57% in 1983–95 to 11.43% in 1996–2008 (P < 0.01). Nephrotoxic AKI showed an increasing trend in recent years (P < 0.01) and mainly caused by rifampicin and NSAIDs. Liver disease-related AKI increased from 1.73% in 1983–95 to 3.17% in 1996–2008 (P < 0.01). Myeloma-associated acute renal failure (ARF) accounted for 1.25% of the total number of ARF cases in the period 1996–2008. HIV infection contributed to 1.65% of ARF of the total number of AKI cases in the second period (1996–2008). Incidence of renal cortical necrosis (RCN) decreased significantly from 5.8% in 1983–95 to 1.3% in 1996–2008 of the total number of ARF cases (P < 0.01). However, during the same period ARF due to acute tubular necrosis, acute glomerulonephritis and acute interstitial nephritis remained unchanged. The mortality rate from AKI decreased significantly from 20% in 1983–95 to 10.98% in 1996–2008 (P < 0.01).ConclusionsThe epidemiological characteristics of CAAKI have changed over the past three decades. There has been an increase in the overall incidence of ARF with the changing etiology of AKI in recent years. Incidences of obstetrical, surgical and diarrheal AKI have decreased significantly, whereas those of AKI associated with malaria, sepsis, nephrotoxic drugs and liver disease have increased. RCN has decreased significantly. In contrast to developed nations, community-acquired AKI is more common in developing countries. It often affects younger individuals and is caused by single and preventable diseases.

The Epidemiology of Acute Kidney Injury in a Tertiary Hospital in Cameroon: A 13 Months Review

“…Other reason included late presentation, etiologic factor (septic choc, multi organ involvement due to nephrotoxic). We found an overall mortality rate of 31.5%, within the range of 10-50% found in tropic literature [3,5,[17][18][19]. Half of patient who die need dialysis but could not beneficed of renal replacement therapy, suggest the impact of limited resources on survival.…”

“…Infection was the main etiologic factor in our study as reported by Chijioke in Nigeria [3] and Jai P in India [5] .Toxic, mainly herbal remedies, is also a common cause of AKI in tropic [4,[6][7][8], we found it in 21 patients (19.5%) with 13 due to herbal concoction. Common nephrotoxic find in Africa included impila (callilepsis laureola), violet tree (securidaca longepedunculata) and cap aloes [4,[6][7][8].…”

“…Obstetrical AKI was found in 11.1% of patient, corresponding to finding of Chijioje in Nigeria (10.5%) [3], Randeree in South Africa (16%) [9] and Jai P in India (8-10%) [5]. Incidence of obstetrical AKI shown a bimodal distribution, the first peak is noted in late first trimester and due to hyperemesis gravidarum and septic abortion, whereas the second peak appear in third trimester and accounted for preeclampsia/ eclampsia, abruption placenta, postpartum hemorrhage and puerperal sepsis [4].…”

Acute Kidney Injury in Sub-Sahara Africa: A Single-Center Experience from Khartoum, Sudan

“…In developing countries, acute glomerulonephritis (GN) remains an important cause of AKI and accounts for 9 to 10% of cases of total AKI and is mainly post-infectious in origin [16]. In our study accounted for about 8% of AKI cases, in agreement with regional and international data.…”

Acute Kidney Injury; Frequency in Hospitalized Patients

“…In hospitals, AKI becomes an important complication when associated with the number and severity of co morbidities experienced by the patients, occurring in a rate around 20% to 40%. 10 Several studies show an increase in its incidence over the last decade. A summary of exiting studies is given in Table- In our study, the most frequent underlying cause requiring hospital admission was a respiratory tract disease observed in 153 (39.9%) patients followed by hepatobiliary diseases (26.4%), infections (23.8%) and diabetes (9.9%).…”