ArticlesRecognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study
Introduction
In high-income countries (HICs), progress in acute kidney injury epidemiology (especially in the critically ill population) has translated into improved prevention, diagnosis, and treatment of acute kidney injury.1 However, in low-income countries (LICs) and lower-middle-income countries (LMICs), epidemiology of acute kidney injury is poorly described.2, 3, 4 In these countries, low availability of resources and inadequate health infrastructure are associated with poor recognition and treatment of acute kidney injury. In LICs and LMICs (LLMICs), the few available studies suggest that a substantial proportion of acute kidney injury cases and their adverse clinical effects could be prevented or attenuated.2
The International Society of Nephrology's 0by25 acute kidney injury initiative aims to prevent all avoidable deaths from acute kidney injury worldwide by 2025.5 As an initial step, we did a Global Snapshot during a 10-week period in 2014 to assess the range of acute kidney injury seen by physicians in different settings worldwide.6 We postulated that differences in risk factors, exposures, and resources available for non-dialytic and dialytic management and follow-up would be associated with dissimilar acute kidney injury outcomes in different settings and countries.
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Study design and participants
The International Society of Nephrology Global Snapshot is a multinational, observational cross-sectional study. We recruited physicians by open invitation via the International Society of Nephrology and partnering nephrology and critical care societies, announcements at national and international meetings, a dedicated website for 0by25, and individual contacts between June 1 and Dec 1, 2014. We recruited 322 providers from 72 countries. Physician participation was voluntary, without financial
Results
322 providers from 289 centres across 72 countries participated in the Global Snapshot (appendix). 27 981 patients were screened for eligibility and data were entered for 3664 adult and 354 paediatric patients with acute kidney injury (figure). 145 (45%) providers were from HICs, 91 (28%) from UMICs, and 85 (26%) from LLMICs (table 1). Data from LICs are presented separately (appendix pp 9–14). 124 (43%) of 289 participant centres were university hospitals and 249 (77%) of the 322 providers
Discussion
Our study is the first worldwide, prospective cross-sectional study designed to assess similarities and differences in recognition and management of acute kidney injury in different health-care settings (community, hospital, ICU, and non-ICU) across six continents. We developed this study to provide baseline evidence for the International Society of Nephrology's 0by25 initiative targeting preventable deaths from acute kidney injury.2 In view of the paucity of information about the natural
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