Acute Kidney Injury Developed in the Intensive Care Unit: a Population-based Prospective Cohort Study in the Brazilian Amazon

Overview

Journal Sci Rep

Specialty Science

Date 2024 Oct 3

PMID 39362971

Authors

Fernando A F Melo

Emmanuel A Burdmann

Etienne Macedo

Ravindra Mehta

Dirce M T Zanetta

Affiliations

Soon will be listed here.

Abstract

The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03-1.23), 1.47 (95% CI 1.07-2.03), 1.96 (95% CI 1.40-2.74), 1.05 (95% CI 1.03-1.08) for each unit increase, and 1.62 (95% CI 1.16-2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29-3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14-1.43) for each 10-year increase, 1.64 (95% CI 1.07-2.52), 2.35 (95% CI 1.14-4.83), 1.88 (95% CI 1.03-3.44), 6.73 (95% CI 4.08-11.09), 2.31 (95% CI 1.52-3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31-180 days after ICU discharge were 3.13 (95% CI 1.84-5.31) and 1.69 (95% CI 0.99-2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.

References

Mehta R, Cerda J, Burdmann E, Tonelli M, Garcia-Garcia G, Jha V . International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015; 385(9987):2616-43. DOI: 10.1016/S0140-6736(15)60126-X. View

ODonnell O . Access to health care in developing countries: breaking down demand side barriers. Cad Saude Publica. 2007; 23(12):2820-34. DOI: 10.1590/s0102-311x2007001200003. View

Macedo E, Hemmila U, Sharma S, Claure-Del Granado R, Mzinganjira H, Burdmann E . Recognition and management of community-acquired acute kidney injury in low-resource settings in the ISN 0by25 trial: A multi-country feasibility study. PLoS Med. 2021; 18(1):e1003408. PMC: 7808595. DOI: 10.1371/journal.pmed.1003408. View

Srisawat N, Kulvichit W, Mahamitra N, Hurst C, Praditpornsilpa K, Lumlertgul N . The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study. Nephrol Dial Transplant. 2019; 35(10):1729-1738. DOI: 10.1093/ndt/gfz087. View

Knapp M, Mayne P . Development of an automated kinetic Jaffé method designed to minimise bilirubin interference in plasma creatinine assays. Clin Chim Acta. 1987; 168(2):239-46. DOI: 10.1016/0009-8981(87)90293-2. View

Thome F, Sesso R, Lopes A, Lugon J, Tzanno Martins C . Brazilian chronic dialysis survey 2017. J Bras Nefrol. 2019; 41(2):208-214. PMC: 6699436. DOI: 10.1590/2175-8239-JBN-2018-0178. View

Koeze J, Keus F, Dieperink W, van der Horst I, Zijlstra J, van Meurs M . Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol. 2017; 18(1):70. PMC: 5319106. DOI: 10.1186/s12882-017-0487-8. View

Adhikari N, Fowler R, Bhagwanjee S, Rubenfeld G . Critical care and the global burden of critical illness in adults. Lancet. 2010; 376(9749):1339-46. PMC: 7136988. DOI: 10.1016/S0140-6736(10)60446-1. View

Kashani K, Macedo E, Burdmann E, Hooi L, Khullar D, Bagga A . Acute Kidney Injury Risk Assessment: Differences and Similarities Between Resource-Limited and Resource-Rich Countries. Kidney Int Rep. 2017; 2(4):519-529. PMC: 5568820. DOI: 10.1016/j.ekir.2017.03.014. View

10.

Assis M, de Jesus W . [Access to health services: approaches, concepts, policies and analysis model]. Cien Saude Colet. 2012; 17(11):2865-75. DOI: 10.1590/s1413-81232012001100002. View

11.

Melo F, Macedo E, Fonseca Bezerra A, de Melo W, Mehta R, Burdmann E . A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries. PLoS One. 2020; 15(1):e0226325. PMC: 6968869. DOI: 10.1371/journal.pone.0226325. View

12.

Lombardi R, Yu L, Younes-Ibrahim M, Schor N, Burdmann E . Epidemiology of acute kidney injury in Latin America. Semin Nephrol. 2008; 28(4):320-329. DOI: 10.1016/j.semnephrol.2008.04.001. View

13.

Komaru Y, Inokuchi R, Iwagami M, Hamasaki Y, Nangaku M, Doi K . Inverse Correlation Between Incidence and Mortality of Acute Kidney Injury in Critically Ill Patients: A Systematic Review. Shock. 2020; 54(3):280-284. DOI: 10.1097/SHK.0000000000001511. View

14.

Bouchard J, Acharya A, Cerda J, Maccariello E, Madarasu R, Tolwani A . A Prospective International Multicenter Study of AKI in the Intensive Care Unit. Clin J Am Soc Nephrol. 2015; 10(8):1324-31. PMC: 4527019. DOI: 10.2215/CJN.04360514. View

15.

Wainstein M, MacDonald S, Fryer D, Young K, Balan V, Begum H . Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC-WHO clinical characterisation protocol. PLoS Med. 2022; 19(4):e1003969. PMC: 9067700. DOI: 10.1371/journal.pmed.1003969. View

16.

Mehta R, Burdmann E, Cerda J, Feehally J, Finkelstein F, Garcia-Garcia G . Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016; 387(10032):2017-25. DOI: 10.1016/S0140-6736(16)30240-9. View

17.

Cerda J, Mohan S, Garcia-Garcia G, Jha V, Samavedam S, Gowrishankar S . Acute Kidney Injury Recognition in Low- and Middle-Income Countries. Kidney Int Rep. 2017; 2(4):530-543. PMC: 5637391. DOI: 10.1016/j.ekir.2017.04.009. View

18.

Hoste E, Bagshaw S, Bellomo R, Cely C, Colman R, Cruz D . Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015; 41(8):1411-23. DOI: 10.1007/s00134-015-3934-7. View

19.

Hoste E, Kellum J, Selby N, Zarbock A, Palevsky P, Bagshaw S . Global epidemiology and outcomes of acute kidney injury. Nat Rev Nephrol. 2018; 14(10):607-625. DOI: 10.1038/s41581-018-0052-0. View

20.

Laake J, Bugge J . [Acute renal failure in critically ill patients]. Tidsskr Nor Laegeforen. 2010; 130(2):158-61. DOI: 10.4045/tidsskr.10.34549. View