Acute kidney injury in the critically ill patient: a review of epidemiological studies in low-middle Income countries

Abstract

Introduction: Acute kidney injury (AKI) refers to the sudden reduction in the kidney's ability to carry out its functions. AKI poses a major health burden in both low and middle income countries (LMIC) resulting in increased morbidity and mortality. It is a common complication in critically ill patients and has the potential of progressing to CKD.The objective of this article is to review the existing epidemiological studies on AKI in ICUs in LMIC.

Methods:  Pubmed, Google Scholar, Web of Science and the Scientific Electronic Library online (SciELO) were searched for published reports, including article reviews on AKI in critically ill patients in LMIC. Search items included key words such as “acute kidney injury”, 'critically ill patient”, 'intensive care unit', 'epidemiology' low and middle income countries, 'developing countries'. The Search occurred between September to November 2022.Articles published from 2010 to 2022 were included in the search. The results reported according to PRISMA 2020 guidelines.

Results: Sixteen studies done in 13 LMIC were identified, with these studies analyzing data from 14835 patients from 51 ICUs within these countries from 2010 to 2022. Out of the studies reviewed, Six were from African countries and ten from non-African countries with male sex preponderance. The mean age of patients in the various studies ranged from 36 to 78 years with similar comorbidities reported such as hypertension, diabetes mellitus, stroke and heart failure. The overall incidence of AKI in ICU ranged from 29% to 58.5%. RIFLE criteria was used to define AKI in 4 of the reported studies with same number using AKIN criteria and lastly, KDIGO used in 8 studies. While most of the studies used just serum creatinine to define AKI, the study done by Passoni et al included urine output as well. Mortality rate was between 25.7%to 68%. Risk factors for AKI in critically ill patients reported from most of the studies reviewed include increasing age, male sex, sepsis, increasing length of ICU stay, hypovolemia and vasopressor use. Also, comorbidities such as hypertension (14%-46%) and diabetes mellitus (13%- 45.9%) was common among patients. The length of ICU stay varied from 2 to 45 days with longer duration of stay noticed for patients with AKI for those reported.

Conclusion: it is reasonable to conclude that the high incidence of AKI and its contributory factors are persistent in LMICs with the associated poor outcomes.