An epidemiologic overview of acute kidney injury in intensive care units

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

INTRODUÇÃO Injúria renal aguda (IRA) é um evento frequente entre pacientes criticamente enfermos internados em unidade de terapia intensiva (UTI) e representa um problema de saúde pública global, sendo imperativa uma abordagem interdisciplinar.

OBJETIVO Investigar, por meio de revisão de literatura, a epidemiologia da IRA em UTIs.

MÉTODOS Pesquisa on-line nas bases de dados Medline, Scientific Electronic Library Online e Literatura Latino-americana e do Caribe em Ciências da Saúde, com análise dos 47 estudos de maior relevância publicados entre 2010 e 2017.

RESULTADOS Foram analisados dados de 67.033 pacientes, internados em mais de 300 UTIs de diferentes regiões do mundo. A incidência global de IRA variou de 2,5% a 92,2% e a mortalidade, entre 5% e 80%. O tempo de internação em UTI variou de cinco a 21 dias, enquanto que a necessidade de terapia renal substitutiva, de 0,8% a 59,2%. Pacientes com IRA apresentam índice de mortalidade substancialmente maior e tempo de internação mais elevado, em comparação com pacientes sem IRA. CONCLUSÃO: A incidência de IRA apresentou alta variabilidade entre os estudos e, dentre os motivos, estão os diferentes critérios utilizados para definição dos casos. Disponibilidade de recursos locais, necessidade de terapia renal substitutiva, creatinina na admissão na UTI, sobrecarga volêmica e sepse, dentre outros, influenciam as taxas de mortalidade entre os pacientes com IRA.

Lesão renal aguda; Unidades de terapia intensiva; Epidemiologia; Fatores de risco

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	-

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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

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[TFN1] *Note: Only articles published between January 2013 and February 2017. Abbreviations: AKIN - Acute Kidney Injury Network; AKIN-m - AKIN modified; CIAI - complicated intra-abdominal infection; CIN – Contrast-induced nephropathy; ClCr – Clearence of creatinine; Cr - Creatinine; Cys-C - Cystatin C; DC - Developed countries; Diff. - Simple difference between patients with and without AKI; EC - Emerging countries; GP - General population; HIV - Human Immunodeficiency Virus; KDIGO - Kidney Disease Improving: Global Outcomes; MV – Mechanical ventilation; NS - Not specified; Ref - Reference; RIFLE - Risk, Injury, Failure, Loss, End-stage kidney disease; RRT – Renal replacement therapy; sCr-a – Serum creatinine adjusted to the water balance; SOFA – Sequential Organ Failure Assessment; UO – Urine Output; V+P – Vancomycin with piperacillin-tazobactam; V+C – Vancomycin with cefepime.