Changing epidemiology and outcomes of acute kidney injury in Brazilian patients: a retrospective study from a teaching h
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NEPHROLOGY - ORIGINAL PAPER
Changing epidemiology and outcomes of acute kidney injury in Brazilian patients: a retrospective study from a teaching hospital Daniela Ponce1,2 · Welder Zamoner1,2 · Marci Maira Batistoco1,2 · André Balbi1,2 Received: 28 November 2019 / Accepted: 13 May 2020 © Springer Nature B.V. 2020
Abstract Purpose While considerable information is available on acute kidney injury (AKI) in North America and Europe, large comprehensive epidemiologic studies on AKI from Latin America and Asia are still lacking. The present study aimed to evaluate the epidemiology and outcomes of AKI in patients evaluated by nephrologists in a Brazilian teaching hospital. Methods We performed a large retrospective observational study that looked into the epidemiology of AKI and its effect on patient outcomes across time periods. For comparison purposes, patients were divided into two groups according to the year of follow up: 2011–2014 and 2015–2018. Results We enrolled 7976 AKI patients and, after excluding patients with chronic kidney disease stages 4 and 5, kidney transplant recipients and those with incomplete data, 5428 AKI patients were included (68%). The maximum AKI stage was 3 (50.6%), and there was a mortality rate of 34.3% (1865 patients). Dialysis treatment was indicated in 928 patients (17.1%). Patient survival improved along the study periods, and patients treated in 2015–2018 had a relative risk death reduction of 0.89 (95% CI 0.81–0.98, p = 0.02). The independent risk factors for mortality were sepsis, > 65 years of age, admission to the intensive care unit, AKI-KDIGO 3, recurrent AKI, no metabolic and fluid demand to capacity imbalance (as a dialysis indication), and the period of treatment. Conclusion We observed an improvement in AKI patient survival over the years, even after correction for several confounders and using a competing risk approach. Identification of risk factors for mortality can help in decision-making for timely intervention, leading to better clinical outcomes. Keywords Acute kidney injury · Epidemiology · Outcome · Period
Introduction Acute kidney injury (AKI) is common and serious, and many aspects of its natural history remain uncertain. It has been suggested that the global burden of AKI is up to 13.3 million cases per year, 85% of which are in low to middle income countries and responsible for up to 1.4 million deaths per year [1–4]. Previous studies performed in developing countries have found an increase in the incidence of AKI and AKI that required dialysis, and a decline in mortality. Despite declining mortality rates, outcomes that are
* Daniela Ponce [email protected] 1
Botucatu School of Medicine, UNESP, Botucatu, Brazil
Clinical Hospital of Botucatu Medical School, Botucatu, Brazil
2
associated with AKI remain unacceptably poor [5, 6]. To reduce preventable mortalities resulting from AKI, there is a need for adequate data on epidemiologic and outcome patterns of this disease in each country [6]. There are few data addressing the epidemiology,
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