Acute Kidney Injury Recognition in Low- and Middle-Income Countries

Abstract

Acute kidney injury (AKI) is increasingly common around the world. Because of the low availability of effective therapies and resource limitations, early preventive and therapeutic measures are essential to decrease morbidity, mortality, and cost. Timely recognition and diagnosis of AKI requires a heightened degree of suspicion in the appropriate clinical and environmental context. In low- and middle-income countries (LMICs), early detection is impaired by limited resources and low awareness. In this article, we report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on how to improve recognition of AKI. We expect these recommendations will lead to an earlier and more accurate diagnosis of AKI, and improved research to promote a better understanding of the epidemiology, etiology, and histopathology of AKI in LMICs.

Keywords: acute kidney injury; biomarkers; detection; developing countries; diagnosis; recognition; resources.

Figure 1

Acute kidney injury (AKI) recognition: the process and its modifiers. In addition to the usual AKI trajectory from clinical suspicion to confirmation to diagnosis, other factors modify the process. The degree of AKI awareness, the context in which the patient is encountered, and the available diagnostic resources may facilitate, delay, or impede the achievement of early AKI diagnosis. CKD, chronic kidney disease; KDIGO, Kidney Disease: Improving Global Outcomes; POC, point of care.

Figure 2

Main components of the acute kidney injury diagnostic context.