Kidney injury responsible for 1.7 million deaths

Kidney injury responsible for 1.7 million deaths

It is responsible for some 1.7 million deaths every year mainly in low and middle income countries. But a new report reveals that by developing strategies for early detection and relatively simple management the vast majority of fatalities could be eliminated by 2025.

The International Society of Nephrology (ISN) "Global Snapshot" of AKI, presented at the ISN World Congress of Nephrology in Cape Town, South Africa, concludes that lives could be saved with as little as $150 per patient.

According to the study, nearly two thirds of the AKI cases were reported to be community-acquired, rather than developing in the hospital setting. The ISN says this is a significant new finding, which points to an opportunity and need for early recognition and detection in these out-of-hospital settings.

The most common causes of AKI reported across all countries were: hypotension and shock, infections, dehydration, cardiac events and nephrotoxic drugs. It was also reported that over two thirds of the AKI cases had one or more of the recognised risk factors for AKI, e.g. diabetes, heart disease and anaemia, and patients with these risk factors experienced a higher mortality and lower rate of recovery of kidney function.

“This study provides us with clear evidence of the need to identify and target high risk groups to improve the prevention and early detection of AKI,” said Dr Ravindra Mehta, who leads the "0by25" project and coordinated the Global Snapshot. “This essential new information can now be used to design targeted education and training to enable the rapid recognition of AKI based on these key indicators.”

Finally, the data findings suggest that over one third of AKI patients were not managed by a nephrologist, a finding that was even more prevalent in low-income countries. “The ISN recognises that AKI is a multi-disciplinary problem and this data just confirms that education and training collaboration with other healthcare disciplines to raise awareness and educate and train non-nephrologists will be essential to reducing the global burden of AKI,” Dr Mehta added.

An average of one fourth of the AKI patients seen by the participating centres required dialysis, but did not receive treatment. This was predominantly due to the late presentation and disease severity of patients, adding further weight to the argument for early detection and management of AKI. In some cases, a lack of healthcare resources and an inability to pay were also reported as barriers to treatment.

The Global Snapshot is the first in a series of landmark projects to be launched by ISN under the 0by25 initiative. ISN says the study was designed to better understand the growing burden of AKI and how it is identified, managed and treated in different settings worldwide.

The study was carried out from September to December 2014 with over 320 participating centres in 72 countries globally. Data was provided for over 4,000 paediatric and adult patients, with significant new information coming from Africa, Asia, and Latin America.

“This is the first time that ISN has carried out a web-based, prospective data collection exercise, simultaneously, in hundreds of centres around the world,” said ISN President, Dr Giuseppe Remuzzi. “The Global Snapshot has helped us address the information gap on AKI and moves us a step closer to our goal of zero preventable deaths. We are excited to share these findings with our international colleagues and the wider global health community.”

By Mark Gould,

OnMedica, Monday 16 March 2015

View this article