EPILAT-IRA Study: A contribution to the understanding of the epidemiology of acute kidney injury in Latin America


Autoři: Raúl Lombardi aff001;  Alejandro Ferreiro aff001;  Rolando Claure-Del Granado aff002;  Emmanuel A. Burdmann aff003;  Guillermo Rosa-Diez aff004;  Luis Yu aff003;  Mauricio Younes-Ibrahim aff005;  Cristina Carlino aff006;  Jonathan S. Chávez-Iñiguez aff007;  Mariana B. Pereira aff008;  Carlos F. Varela aff004;  Welder Zamoner aff009;  Diego Janiques aff010;  Soledad Lecueder aff011;  Víctor Cerrón-Millán aff012;  Alfonso Cueto-Manzano aff013
Působiště autorů: Dept. of Nephrology, School of Medicine, Universidad de la República, Montevideo, Uruguay aff001;  Division of Nephrology, Hospital Obrero #2 - C.N.S., Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia aff002;  LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil aff003;  Dept. of Nehrology, Hospital Italiano, Buenos Aires, Argentina aff004;  Dept. of Internal Medicine, University of Rio de Janeiro, Rio de Janeiro, Brazil aff005;  Hospital Provincial, Rosario, Santa Fe, Argentina aff006;  Hospital Civil de Guadalajara, Centro Universitario de Ciencias de la Salud, Jalisco, Mexico aff007;  Nephrology Division, Hospital do Servidor Público Estadual, Universidade Nove de Julho, Sao Paulo, Brazil aff008;  Botucatu School of Medicine, São Paulo State University-UNESP, Sao Paulo, Brazil aff009;  Clinica Renalle, Pontifícia Universidade Católica, Petrópolis, Rio de Janeiro, Brazil aff010;  Sanatorio Casa de Galicia, Montevideo, Uruguay aff011;  Hospital Nacional Daniel Alcides Carrión, Dept. de Medicina, Servicio de Nefrología, Callao- Lima, Perú aff012;  Medical Research Unit of Renal Diseases, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico aff013
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224655

Souhrn

Introduction

Epidemiology of acute kidney injury (AKI) is highly dependent on patient characteristics, context and geography. Considering the limited information in Latin America and the Caribbean, we performed a study with the aim to contribute to improve its better understanding.

Methods

Observational, prospective, longitudinal, multinational cohort study addressed to determine risk factors, clinical profile, process of care and outcomes of AKI in the region. Patients meeting KDIGO AKI definition were included over a 9-month period and designated community or hospital-acquired. De-identified clinical and lab data were entered in a specifically designed on-line platform. Co-variables potentially linked to AKI onset, in-hospital and 90-days mortality, were recorded and correlated using a multiple logistic regression model.

Results

Fifty-seven physicians from 15 countries provided data on 905 patients, most with acceptable basic needs coverage. Median age 64 (50–74) yrs; most of them were male (61%) and mestizos (42%). Comorbidities were present in 77%. AKI was community-acquired in 62%. Dehydration, shock and nephrotoxic drugs were the commonest causes. During their process of care, 77% of patients were assessed by nephrologists. Kidney replacement therapy (KRT) was performed in 29% of cases. In-hospital mortality was 26.5% and independently associated to older age, chronic liver disease, hypotension, shock, cardiac disturbances, hospital-acquired sepsis, KRT and mechanical ventilation. At 90-days follow up partial or complete renal recovery was 81% and mortality 24%.

Conclusions

AKI was mainly community-acquired, in patients with comorbidities and linked to fluid loss and nephrotoxic drugs. Mortality was high and long-term follow up poor. Notwithstanding, the study shows partially the situation in the participant countries rather than the actual epidemiology of AKI in Latin America and Caribbean, a pending and needed task.

Klíčová slova:

Death rates – Epidemiology – Kidneys – Medical dialysis – Medical risk factors – Nephrology – Nosocomial infections – Sepsis


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