International Society of Nephrology 0 by 25 Project: Lessons Learned

Abstract

Acute kidney injury (AKI) is a common disorder with a high risk of mortality and development of chronic kidney disease. With the validation of the recent classification systems, RIFLE in 2004 and KDIGO, in use today, our understanding of AKI has evolved. We now know that community-acquired AKI is also associated with an increased risk of worse outcomes. In addition, several epidemiological studies, including cohorts from low-income and low-middle income countries, have confirmed common risk factors for community-acquired AKI. In 2013, the International Society of Nephrology launched the 0 by 25 campaign with the goal that no patient should die from preventable or untreated AKI in low-resource areas by 2025 [Mehta et al.: Lancet 2015;385:2616–43]. The initial effort of the initiative was a meta-analysis of AKI epidemiology around the world. The second project of the 0 by 25 initiative, the Global AKI Snapshot (GSN) study, provided insights into the recognition, treatment, and outcomes of AKI worldwide [Mehta et al.: Lancet 2016;387:2017–25]. Following the GSN, a Pilot Project was designed to test whether education and a simple protocol-based approach can improve outcomes in patients at risk of community-acquired AKI in low-resource settings [Macedo: J Am Soc Nephrol 2017]. In this review, we will comment on the main findings and lessons learned from the 0 by 25 initiative.

Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan

“…AKI is a growing problem worldwide, consuming a lot of resources, and can be variable between high- and low-income countries [ 15 ]. Its association with mortality, morbidity, CKD, and prolonged hospitalization especially in critically ill patients and patients admitted to ICU is well documented in the literature, which reflects the worldwide importance of early detection and prevention with the aim of decreasing death and morbidity [ 16 – 18 ].…”

Diagnostic performance of a point-of-care saliva urea nitrogen dipstick to screen for kidney disease in low-resource settings where serum creatinine is unavailable

“…We conducted a prospective multicentre cross-sectional study in five healthcare facilities in Malawi, which were participating in the 0by25 feasibility project. 20 These included three health centres (Bangwe Health Centre, Gateway Clinic and Chileka Health Centre), a rural district hospital (Chikwawa district hospital) and a central hospital (Queen Elizabeth Central Hospital, QECH, Blantyre) (online supplementary figure s1). Malawi is ranked as one of the poorest countries worldwide, but despite this government-funded healthcare is provided free at the point of delivery to all.…”

Overview of sepsis associated acute kidney injury: literature review

“…Moreover, it has been estimated that around 50% of critically-ill patients are affected by AKI morbidity. 1,2 The prognosis of AKI is usually bad when associated with other comorbidities which is the case with Sepsis is estimated to be the commonest cause for AKI development in critically-ill patients; contributing to the pathology in 20-50% of the cases. Although sepsis is estimated to be the commonest cause for developing AKI, AKI attributable to other etiologies have been also associated with the development of sepsis.…”