A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries

Autor(es)

Ferreira Melo, Fernando de Assis ^[1] ; Macedo, Etienne ^[2] ; Fonseca Bezerra, Ana Caroline ^[1] ; Lopes de Melo, Waledya Araujo ^[1] ; Mehta, Ravindra L. ^[2] ; Burdmann, Emmanuel de Almeida ^[3] ; Trevisan Zanetta, Dirce Maria ^[4]

Afiliação do(s) autor(es)

^[1] Acre Fed Univ, Div Urol, Rio Branco, Acre - Brazil

^[2] Univ Calif San Diego UCSD, Dept Med, San Diego, CA - USA

^[3] Univ Sao Paulo, Div Nephrol, Med Sch, LIM 12, Sao Paulo, SP - Brazil

^[4] Univ Sao Paulo, Dept Epidemiol, Sch Publ Hlth, Sao Paulo, SP - Brazil

• Tipo de documento: Artigo de Revisão
• Fonte: PLoS One; v. 15, n. 1 JAN 17 2020.
• Citações Web of Science: 4

Resumo

Objectives Although the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence. Methods A systematic review of published studies reporting AKI in intensive care units (2005-2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model. Results Ninety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the meta-analysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries. Conclusion Although patient characteristics and AKI incidence were similar in developed and developing countries, main outcomes were worse in developing country studies. There are significant caveats when comparing AKI epidemiology in developed and developing countries, including lack of standardization of reference serum creatinine, oliguria and the timeframe for AKI assessment. Larger, prospective, multicenter studies from developing countries are urgently needed to capture AKI data from the overall population without ICU access. (AU)

• Processo FAPESP: 14/19286-4 - Indivíduos com alto risco para desenvolvimento de injúria renal aguda em contextos clínicos relevantes: estudo prospectivo sobre aspectos epidemiológicos, diagnósticos e prognósticos
• Beneficiário: Emmanuel de Almeida Burdmann
• Modalidade de apoio: Auxílio à Pesquisa - Temático