An epidemiologic overview of acute kidney injury in intensive care units

Santos, Reginaldo Passoni dos; Carvalho, Ariana Rodrigues Silva; Peres, Luis Alberto Batista; Ronco, Claudio; Macedo, Etienne

doi:10.1590/1806-9282.65.8.1094

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW ARTICLES • Rev. Assoc. Med. Bras. 65 (8) • Aug 2019 • https://doi.org/10.1590/1806-9282.65.8.1094 copy

An epidemiologic overview of acute kidney injury in intensive care units

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

INTRODUCTION

Acute kidney injury (AKI) is a frequent event among critically ill patients hospitalized in intensive care units (ICU) and represents a global public health problem, being imperative an interdisciplinary approach.

OBJECTIV

To investigate, through literature review, the AKI epidemiology in ICUs. METHODS: Online research in Medline, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences databases, with analysis of the most relevant 47 studies published between 2010 and 2017.

RESULTS

Data of the 67,033 patients from more than 300 ICUs from different regions of the world were analyzed. The overall incidence of AKI ranged from 2.5% to 92.2%, and the mortality from 5% to 80%. The length of ICU stay ranged from five to twenty-one days, and the need for renal replacement therapy from 0.8% to 59.2%. AKI patients had substantially higher mortality rates and longer hospital stays than patients without AKI.

CONCLUSION

AKI incidence presented high variability among the studies. One of the reasons for that were the different criteria used to define the cases. Availability of local resources, renal replacement therapy needs, serum creatinine at ICU admission, volume overload, and sepsis, among others, influence mortality rates in AKI patients.

Acute kidney injury; Intensive care units; Epidemiology; Risk factors

Ref	Patients		Criteria for AKI	Epidemiological data of AKI
	n	Setting		Incidence (%)	RRT (%)	Mortality endpoint	Mortality (%)			Length of stay (days)
	n	Setting		Incidence (%)	RRT (%)	Mortality endpoint	With AKI	Without AKI	Diff.	With AKI	Without AKI	Diff.
[1]	1,802	GP	KDIGO	57.3	23.5	ICU Hospital	24 26.9	4.7 7.2	+19.3 +19.7	ICU: 6 Hospital: 15	4 12	+2 +3
[2]	6,647	GP	AKIN-m	DC: 19.1 EC: 19.9 Both: 19.2	15.5 30.2 23.7	Hospital	DC: 27.6 EC: 17.6 Both: 22 RRT: 32.3	NS	-	UTI: DC: 5 EC: 6 Hospital: DC: 11 EC: 10	NS	-
[6]	8,085	GP	KDIGO	2.5	45	NS	NS	NS	-	NS	NS	-
[7]	51	Post-surgery cardiac	KDIGO	92.2	NS	NS	NS	NS	-	NS	NS	-
[8]	1,087	Post-surgery myocardial injury	KDIGO	5.2	NS	30 days	5.3	NS	-	NS	NS	-
[9]	7,696	Volume overload	KDIGO sCr-a	24.2 25.3	NS	60 days	5.4	NS	-	NS	NS	-
[10]	73	HIV	RIFLE	All	23.3	ICU	75.3	-	-	1	-	-
[11]	269	GP versus Sepsis	RIFLE	GP: 8.9 Sepsis: 32.3	AKI: 1.9 AKI+Sepsis 15	ICU	AKI: 66.7 AKI+ Sepsis: 80	GP: 21.2 Sepsis: 45.2	+45.5 +34.8	AKI: 8 AKI+Sepsis 11	GP: 9 Sepsis: 13	-1 -2
[12]	152	GP	RIFLE	65.8	12.4	ICU	AKI: 52 RRT: 84.2	5.8	+46.2	8.5	7	+1.5
[13]	476	GP	AKIN	52.7	0.8	ICU	58	27.5	+30.5	NS	NS	-
[14]	414	Severe acute pancreatitis	AKIN	69.3	59.2	ICU	44.9	20.5	+24.4	24	22	+2
[15]	389	Cancer	KDIGO	Cr: 49.4 UO: 56.3 Both: 69.4	5.9	ICU 180 days	30 51.5	5 15.1	+25 +36.4	5	2	+3
[16]	122	V+P versus V+C	AKIN	V+P: 32.7 V+C: 28.8	V+P: 18.8 V+C: 38.1	NS	NS	-	-	V+P: 17.8 V+C: 21.4	-	-
[17]	74	RRT	NS	27	All	NS	NS	-	-	ICU: 18 Hospital: 36	-	-
[23]	1,036	GP	RIFLE AKIN KDIGO Cys-C	26.4 34.1 37.8 36.1	NS	28 days	57.9 54.4 51.8 52.1	NS	-	13.5 12.9 13.9 13.2	(±) 5	+8.5 +7.9 +8.9 +8.2
[24]	200	Elderly (>60 years)	KDIGO	27	NS	ICU	48.1	15.7	+32.4	11.4	5.2	+6.2
[25]	137	Sepsis	AKIN	77	23.4	ICU Hospital 28 days	39 45 38	NS	-	NS	NS	-
[26]	573	Volume overload	SOFA	23	50.8	28 days	50	13.4	+36.6	15.3	NS	-
[27]	1,234	RRT	RIFLE/ AKIN	All	All	ICU	69.4	-	-	9.8	-	-
[28]	14,986	Obesity	KDIGO	21.1	NS	Hospital 1 year	10 12	NS	-	NS	NS	-
[29]	832	GP	CrCl/ AKIN	CrCl: 58.3 AKIN: 27	CrCl:9.5 AKINNS	ICU	CrCl: 26.2 AKIN: NS	CrCl: 10.7 AKIN: NS	+15.5 -	CrCl: 13.5 AKIN: NS	CrCl: 10 AKIN: NS	+3.5 -
[30]	190	GP	RIFLE AKIN KDIGO	62.6 63.2 63.2	NS	ICU	42.9 42.5 42.5	17.7 17.7 17.74	+25.2 +24.8 +24.8	NS	NS	-
[31]	335	CIN	RIFLE	15.5	34.6	ICU Hospital	40.4 53.8	21.3 35.7	+19.1 +18.1	ICU: 14	ICU: 15	-1
[32]	41	RRT	RIFLE	All	All	ICU Hospital	48.8 53.7	-	-	9	-	-
[33]	548	GP	RIFLE	17.2	4.3	28 days	49	NS		NS	NS	-
[34]	254	Infections diseases	RIFLE	All	27.6	ICU	62.8	-	-	NS	-	-
[35]	3.107	GP	RIFLE/AKIN/KDIGO	46.9 38.4 51	(±) 20	Hospital	27.8 32.2 27.4	7 7.1 5.6	+20.8 +25.1 +21.8	5	3	+2
[36]	2,526	GP	KDIGO	46.4	18.9	28 days	25.7	10.1	+15.1	7	5	+2
[37]	65	GP	RIFLE/AKIN	All	48	ICU	69	NS	-	NS	NS	-
[38]	901	Trauma	AKIN	6	19	30 days	29.6 RRT: 50	7.9	+21.7	NS	NS	-
[39]	114	CIAI	AKIN	58.8	28.9	ICU 28 days	17.9 23.9	NS	-	NS	NS	-
[40]	360	GP	AKIN	59.7	(±) 2.3	ICU	(±) 60.2	18.6	+41.6	ICU (±): 11.9 Hospital: (±) 22.7	ICU: 7.2 Hospital: 27.2	+4.7 -4.5
[41]	715	GP	RIFLE	16.1	39.1	ICU 28 days	7.8 49.5	NS	-	ICU: 11	NS	-
[42]	40	RRT	NS	All	All	30 days	52.5	-	-	NS	-	-
[43]	44	GP	AKIN	All	43.2	ICU	43.2	NS	-	NS	NS	-
[44]	627	GP	RILE/ AKIN	RIFLE: 69.4 AKIN: 51.8 Both: 74.4	5.4	90 days	40.9 44.6	19.8 23.5	+21.1	14	14	-
[45]	149	CIN	RIFLE	15.4	13	ICU	52	19	+33	13	12	+1
[46]	2,901	GP	AKIN/KDIGO	39.3	10.2	Hospital 90 days	25.6 33.7	NS	-	3.7	NS	-
[47]	624	Surgical	RIFLE	58	8	Hospital 1 year	19 35	4 14	+15 +21	ICU: 6 Hospital: 19	ICU: 3 Hospital: 9	+3 +10
[48]	274	RRT	RIFLE	All	All	ICU Hospital	58.4 62	-	-	ICU: 14 Hospital: 22	-	-
[49]	182	Post-partum	Cr≥ 89µmol/RIFLE	37.3	28	NS	NS	NS	-	4	2	+2
[50]	1,769	GP	AKIN	28.9	NS	30 days 1 year	13.3 28.8	6.0 16.5	+7.3 +12.3	NS	NS	-
[51]	40	GP	RIFLE	75	NS	ICU	30	10	+20	NS	NS	-
[52]	1,070	GP	RIFLE	Men: 35.8 Women: 38.7 Both: 37.3	NS	NS	NS	NS	-	NS	NS	-
[53]	445	GP	KDIGO	48.8	33.2	90 days	15.3	NS	-	(±) 4.3	2.1	2.2
[54]	27	MV	RIFLE	All	NS	ICU	44.4	NS	-	NS	NS	-
[55]	3,350	GP	RIFLE/ AKIN	21 21.1	NS	ICU	46.5 47	NS	-	NS	NS	-

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] CORRESPONDING AUTHOR: Reginaldo Passoni dos Santos Rua Cabo Clodoaldo Ursulano, 426 - Santa Felicidade - Cascavel/PR. Brasil. CEP: 85.803-450 E-mail: regi-pas@hotmail.com