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Meta-Analysis
. 2024 Aug 1;52(8):1264-1274.
doi: 10.1097/CCM.0000000000006284. Epub 2024 Apr 1.

Quantifying the Impact of Alternative Definitions of Sepsis-Associated Acute Kidney Injury on its Incidence and Outcomes: A Systematic Review and Meta-Analysis

Lachlan H Donaldson  1   2 , Ruan Vlok  2 , Ken Sakurai  2 , Morgan Burrows  3 , Gabrielle McDonald  2 , Karthik Venkatesh  1   2 , Sean M Bagshaw  4 , Rinaldo Bellomo  5   6 , Anthony Delaney  1   2 , John Myburgh  1   7 , Naomi E Hammond  1   2 , Balasubramanian Venkatesh  1   8   9
Affiliations
Meta-Analysis

Quantifying the Impact of Alternative Definitions of Sepsis-Associated Acute Kidney Injury on its Incidence and Outcomes: A Systematic Review and Meta-Analysis

Lachlan H Donaldson et al. Crit Care Med. .

Abstract

Objectives: To derive a pooled estimate of the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients and to explore the impact of differing definitions of SA-AKI on these estimates.

Data sources: Medline, Medline Epub, EMBASE, and Cochrane CENTRAL between 1990 and 2023.

Study selection: Randomized clinical trials and prospective cohort studies of adults admitted to the ICU with either sepsis and/or SA-AKI.

Data extraction: Data were extracted in duplicate. Risk of bias was assessed using adapted standard tools. Data were pooled using a random-effects model. Heterogeneity was assessed by using a single covariate logistic regression model. The primary outcome was the proportion of participants in ICU with sepsis who developed AKI.

Data synthesis: A total of 189 studies met inclusion criteria. One hundred fifty-four reported an incidence of SA-AKI, including 150,978 participants. The pooled proportion of patients who developed SA-AKI across all definitions was 0.40 (95% CI, 0.37-0.42) and 0.52 (95% CI, 0.48-0.56) when only the Risk Injury Failure Loss End-Stage, Acute Kidney Injury Network, and Improving Global Outcomes definitions were used to define SA-AKI. There was significant variation in the incidence of SA-AKI depending on the definition of AKI used and whether AKI defined by urine output criteria was included; the incidence was lowest when receipt of renal replacement therapy was used to define AKI (0.26; 95% CI, 0.24-0.28), and highest when the Acute Kidney Injury Network score was used (0.57; 95% CI, 0.45-0.69; p < 0.01). Sixty-seven studies including 29,455 participants reported at least one SA-AKI outcome. At final follow-up, the proportion of patients with SA-AKI who had died was 0.48 (95% CI, 0.43-0.53), and the proportion of surviving patients who remained on dialysis was 0.10 (95% CI, 0.04-0.17).

Conclusions: SA-AKI is common in ICU patients with sepsis and carries a high risk of death and persisting kidney impairment. The incidence and outcomes of SA-AKI vary significantly depending on the definition of AKI used.

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Conflict of interest statement

Dr. Bagshaw is supported by a Canada Research Chair in Critical Care Outcomes and Systems Evaluation. Drs. Bagshaw and Hammond received funding from Baxter. Dr. Bagshaw received funding from Novartis, Bioporto, and Sea Star Medical. Dr. Hammond received funding from CSL Behring, Grifols, and Revimmune. Dr. Venkatesh’s institution received funding from Baxter and the National Health and Medical Research Council. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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    1. Gomez H, Ince C, De Backer D, et al.: A unified theory of sepsis-induced acute kidney injury: Inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 2014; 41:3–11
    1. Khwaja A: KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120:c179–c184
    1. Singer M, Deutschman CS, Seymour CW, et al.: The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016; 315:801–810
    1. Angus DC, Linde-Zwirble WT, Lidicker J, et al.: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29:1303–1310

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