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A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries

OBJECTIVES: Although the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI pat...

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Autores principales: Melo, Fernando de Assis Ferreira, Macedo, Etienne, Fonseca Bezerra, Ana Caroline, de Melo, Walédya Araújo Lopes, Mehta, Ravindra L., Burdmann, Emmanuel de Almeida, Zanetta, Dirce Maria Trevisan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968869/
https://www.ncbi.nlm.nih.gov/pubmed/31951618
http://dx.doi.org/10.1371/journal.pone.0226325
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author Melo, Fernando de Assis Ferreira
Macedo, Etienne
Fonseca Bezerra, Ana Caroline
de Melo, Walédya Araújo Lopes
Mehta, Ravindra L.
Burdmann, Emmanuel de Almeida
Zanetta, Dirce Maria Trevisan
author_facet Melo, Fernando de Assis Ferreira
Macedo, Etienne
Fonseca Bezerra, Ana Caroline
de Melo, Walédya Araújo Lopes
Mehta, Ravindra L.
Burdmann, Emmanuel de Almeida
Zanetta, Dirce Maria Trevisan
author_sort Melo, Fernando de Assis Ferreira
collection PubMed
description OBJECTIVES: Although the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence. METHODS: A systematic review of published studies reporting AKI in intensive care units (2005–2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model. RESULTS: Ninety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the meta-analysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries. CONCLUSION: Although patient characteristics and AKI incidence were similar in developed and developing countries, main outcomes were worse in developing country studies. There are significant caveats when comparing AKI epidemiology in developed and developing countries, including lack of standardization of reference serum creatinine, oliguria and the timeframe for AKI assessment. Larger, prospective, multicenter studies from developing countries are urgently needed to capture AKI data from the overall population without ICU access.
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spelling pubmed-69688692020-01-26 A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries Melo, Fernando de Assis Ferreira Macedo, Etienne Fonseca Bezerra, Ana Caroline de Melo, Walédya Araújo Lopes Mehta, Ravindra L. Burdmann, Emmanuel de Almeida Zanetta, Dirce Maria Trevisan PLoS One Research Article OBJECTIVES: Although the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence. METHODS: A systematic review of published studies reporting AKI in intensive care units (2005–2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model. RESULTS: Ninety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the meta-analysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries. CONCLUSION: Although patient characteristics and AKI incidence were similar in developed and developing countries, main outcomes were worse in developing country studies. There are significant caveats when comparing AKI epidemiology in developed and developing countries, including lack of standardization of reference serum creatinine, oliguria and the timeframe for AKI assessment. Larger, prospective, multicenter studies from developing countries are urgently needed to capture AKI data from the overall population without ICU access. Public Library of Science 2020-01-17 /pmc/articles/PMC6968869/ /pubmed/31951618 http://dx.doi.org/10.1371/journal.pone.0226325 Text en © 2020 Melo et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Melo, Fernando de Assis Ferreira
Macedo, Etienne
Fonseca Bezerra, Ana Caroline
de Melo, Walédya Araújo Lopes
Mehta, Ravindra L.
Burdmann, Emmanuel de Almeida
Zanetta, Dirce Maria Trevisan
A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
title A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
title_full A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
title_fullStr A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
title_full_unstemmed A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
title_short A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
title_sort systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968869/
https://www.ncbi.nlm.nih.gov/pubmed/31951618
http://dx.doi.org/10.1371/journal.pone.0226325
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