World incidence of AKI: a meta-analysis

Abstract

Background and objectives: The burden of AKI around the globe has not been systematically examined.

Design, setting, participants, & measurements: A systematic review (2004-2012) of large cohort studies was conducted to estimate the world incidence of AKI and its stages of severity and associated mortality, and to describe geographic variations according to countries, regions, and their economies. AKI definitions were reclassified according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system. Random-effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity.

Results: There were 312 studies identified (n=49,147,878) , primarily in hospital settings. Most studies originated from North America, Northern Europe, and Eastern Asia, from high-income countries, and from nations that spent ≥5% of the gross domestic product on total health expenditure. Among the 154 studies (n=3,585,911) that adopted a KDIGO-equivalent AKI definition, the pooled incidence rates of AKI were 21.6% in adults (95% confidence interval [95% CI], 19.3 to 24.1) and 33.7% in children (95% CI, 26.9 to 41.3). The pooled AKI-associated mortality rates were 23.9% in adults (95% CI, 22.1 to 25.7) and 13.8% in children (95% CI, 8.8 to 21.0). The AKI-associated mortality rate declined over time, and was inversely related to income of countries and percentage of gross domestic product spent on total health expenditure.

Conclusions: Using the KDIGO definition, 1 in 5 adults and 1 in 3 children worldwide experience AKI during a hospital episode of care. This analysis provides a platform to raise awareness of AKI with the public, government officials, and health care professionals.

Figure 1.

Literature search and selection. KDIGO, Kidney Disease Improving Global Outcomes.

Figure 2.

Pooled incidence rate of AKI in studies that used KDIGO-equivalent serum creatinine-based AKI definition and staging system, or dialysis requirement. Some studies and patients are included in more than one category. KDIGO, Kidney Disease Improving Global Outcomes; 95% CI, 95% confidence interval.

Figure 3.

Pooled incidence rate of AKI by world zones in studies that used a KDIGO-equivalent serum creatinine-based AKI definition. Some studies and patients are included in more than one category. KDIGO, Kidney Disease Improving Global Outcomes.

Figure 4.

Pooled AKI-associated mortality rate in studies that used a KDIGO-equivalent serum creatinine-based AKI definition and staging system, or dialysis requirement. Some studies and patients are included in more than one category. KDIGO, Kidney Disease Improving Global Outcomes; 95% CI, 95% confidence interval.

Figure 5.

Pooled unadjusted odds ratio for all-cause mortality in patients with AKI relative to patients without AKI in studies that used a KDIGO-equivalent serum creatinine-based AKI definition and staging system, or dialysis requirement. Some studies and patients are included in more than one category. KDIGO, Kidney Disease Improving Global Outcomes; 95% CI, 95% confidence interval.