Background: Acute kidney injury (AKI) is frequent and is associated with poor outcomes, including increased mortality, higher risk of chronic kidney disease, and prolonged hospital lengths of stay. The epidemiology of AKI mainly derives from studies performed in Western high-income countries. More limited data are available from Western low-income and middle-income countries (LMICs) located in Central and South America. Summary: In this review, we summarize the most recent data on the epidemiology of AKI in Western countries, aiming to contrast results from industrialized high-income countries with LMICs. The global picture of AKI in LMICs is not as well characterized as in the USA and Europe. In addition, in some LMICs, the epidemiology of AKI may vary depending on the region and socioeconomic status, which contributes to the difficulty of getting a better portrait of the clinical condition. In low-income regions and tropical countries, AKI is frequently attributed to diarrhea, infections, nephrotoxins, as well as obstetric complications. As opposed to the situation in high-income countries, access to basic care in LMICs is limited by economic constraints, and treatment is often delayed due to late presentation and recognition of the condition, which contribute to worse outcomes. In addition, dialysis is often not available or must be paid by patients, which further restricts its use. Key Messages: There are great disparities in the epidemiology of AKI between Western high-income countries and Western LMICs. In LMICs, education and training programs should increase the public awareness of AKI and improve preventive and basic treatments to improve AKI outcomes. Facts from East and West: (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion management must be improved to reduce AKI in women, particularly in rural areas. (6) Earlier nephrology referral and better access to peritoneal dialysis should improve the outcome of AKI patients.

1.
Mehta RL, Cerda J, Burdmann EA, Tonelli M, Garcia-Garcia G, Jha V, Susantitaphong P, Rocco M, Vanholder R, Sever MS, Cruz D, Jaber B, Lameire NH, Lombardi R, Lewington A, Feehally J, Finkelstein F, Levin N, Pannu N, Thomas B, Aronoff-Spencer E, Remuzzi G: International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015;385:2616-2643.
2.
Cerda J, Lameire N, Eggers P, Pannu N, Uchino S, Wang H, Bagga A, Levin A: Epidemiology of acute kidney injury. Clin J Am Soc Nephrol 2008;3:881-886.
3.
Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, Liu KD, Mehta RL, Pannu N, Van Biesen W, Vanholder R: Acute kidney injury: an increasing global concern. Lancet 2013;382:170-179.
4.
Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, Jaber BL; Acute Kidney Injury Advisory Group of the American Society of Nephrology: World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 2013;8:1482-1493.
5.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.
6.
Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS: Community-based incidence of acute renal failure. Kidney Int 2007;72:208-212.
7.
Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KE, Garg AX, Harel Z, Kitchlu A, Mazer CD, Nash DM, Scales DC, Silver SA, Ray JG, Friedrich JO: Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis 2015;65:870-877.
8.
Rewa O, Bagshaw SM: Acute kidney injury - epidemiology, outcomes and economics. Nat Rev Nephrol 2014;10:193-207.
9.
Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A: Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 2007;18:1292-1298.
10.
Goldstein SL, Jaber BL, Faubel S, Chawla LS; Acute Kidney Injury Advisory Group of American Society of Nephrology: AKI transition of care: a potential opportunity to detect and prevent CKD. Clin J Am Soc Nephrol 2013;8:476-483.
11.
Hsu RK, McCulloch CE, Heung M, Saran R, Shahinian VB, Pavkov ME, Burrows NR, Powe NR, Hsu CY; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team: Exploring potential reasons for the temporal trend in dialysis-requiring AKI in the United States. Clin J Am Soc Nephrol 2016;11:14-20.
12.
Liano F, Pascual J: Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50:811-818.
13.
Finlay S, Bray B, Lewington AJ, Hunter-Rowe CT, Banerjee A, Atkinson JM, Jones MC: Identification of risk factors associated with acute kidney injury in patients admitted to acute medical units. Clin Med 2013;13:233-238.
14.
Frenette AJ, Bouchard J, Bernier P, Charbonneau A, Nguyen LT, Rioux JP, Troyanov S, Williamson DR: Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis. Crit Care 2014;18:602.
15.
Haase M, Bellomo R, Matalanis G, Calzavacca P, Dragun D, Haase-Fielitz A: A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: a prospective cohort study. J Thorac Cardiovasc Surg 2009;138:1370-1376.
16.
Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, Liang X, Fu P, Liu ZH, Mehta RL: A prospective international multicenter study of AKI in the intensive care unit. Clin J Am Soc Nephrol 2015;10:1324-1331.
17.
Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, Edipidis K, Forni LG, Gomersall CD, Govil D, Honore PM, Joannes-Boyau O, Joannidis M, Korhonen AM, Lavrentieva A, Mehta RL, Palevsky P, Roessler E, Ronco C, Uchino S, Vazquez JA, Vidal Andrade E, Webb S, Kellum JA: Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015;41:1411-1423.
18.
Santos WJ, Zanetta DM, Pires AC, Lobo SM, Lima EQ, Burdmann EA: Patients with ischaemic, mixed and nephrotoxic acute tubular necrosis in the intensive care unit - a homogeneous population? Crit Care 2006;10:R68.
19.
Saravu K, Rishikesh K, Parikh CR: Risk factors and outcomes stratified by severity of acute kidney injury in malaria. PLoS One 2014;9:e90419.
20.
Daher Ede F, Junior Silva GB, Vieira AP, Souza JB, Falcao Fdos S, Costa CR, Fernandes AA, Lima RS: Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit. Rev Soc Bras Med Trop 2014;47:86-89.
21.
Cerda J, Bagga A, Kher V, Chakravarthi RM: The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol 2008;4:138-153.
22.
Lombardi R, Yu L, Younes-Ibrahim M, Schor N, Burdmann EA: Epidemiology of acute kidney injury in Latin America. Semin Nephrol 2008;28:320-329.
23.
Vannaphan S, Walters N, Saengnedsawang T, Tangpukdee N, Kham-In P, Klubprasit M, Wilairatana P, Looareesuwan S: Factors associated with acute renal failure in severe falciparum [corrected] malaria patients. Southeast Asian J Trop Med Public Health 2010;41:1042-1047.
24.
Koopmans LC, van Wolfswinkel ME, Hesselink DA, Hoorn EJ, Koelewijn R, van Hellemond JJ, van Genderen PJ: Acute kidney injury in imported Plasmodium falciparum malaria. Malar J 2015;14:523.
25.
Cruz LS, Vargas R, Lopes AA: Leptospirosis: a worldwide resurgent zoonosis and important cause of acute renal failure and death in developing nations. Ethn Dis 2009;19(1 suppl 1):S1-37-41.
26.
Daher EF, Vieira AP, Jacinto CN, Lima RS, Girao MM, Fernandes AT, Neto RJ, Silva GBJ: Differences among children, adolescents and adults with severe leptospirosis: a comparative analysis. Indian J Nephrol 2014;24:166-170.
27.
Tubiana S, Mikulski M, Becam J, Lacassin F, Lefevre P, Gourinat AC, Goarant C, D'Ortenzio E: Risk factors and predictors of severe leptospirosis in New Caledonia. PLoS Negl Trop Dis 2013;7:e1991.
28.
Oliveira JF, Burdmann EA: Dengue-associated acute kidney injury. Clin Kidney J 2015;8:681-685.
29.
Albuquerque PL, Silva GB Jr, Jacinto CN, Lima JB, Lima CB, Amaral YS, Veras Mdo S, Mota RM, Daher EF: Acute kidney injury after snakebite accident treated in a Brazilian tertiary care centre. Nephrology 2014;19:764-770.
30.
Fakhouri F, Vercel C, Fremeaux-Bacchi V: Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy. Clin J Am Soc Nephrol 2012;7:2100-2106.
31.
Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Magee LA, Kramer MS, Liston RM, Joseph KS; Canadian Perinatal Surveillance System Public Health Agency of Canada: Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. BMJ 2014;349:g4731.
32.
Silva GB Jr, Monteiro FA, Mota RM, Paiva JG, Correia JW, Bezerra Filho JG, Macedo RN, Lima RS, Daher EF: Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil. Arch Gynecol Obstet 2009;279:131-137.
33.
Aitken E, Carruthers C, Gall L, Kerr L, Geddes C, Kingsmore D: Acute kidney injury: outcomes and quality of care. QJM 2013;106:323-332.
34.
Stewart J, Findlay G, Smith N, Kelly K, Mason M: Adding Insult to Injury: A Review of the Care of Patients Who Died in Hospital with a Primary Diagnosis of Acute Kidney Injury (Acute Renal Failure). London, National Confidential Enquiry into Patient Outcome and Death, 2009.
35.
Cho A, Lee JE, Yoon JY, Jang HR, Huh W, Kim YG, Kim DJ, Oh HY: Effect of an electronic alert on risk of contrast-induced acute kidney injury in hospitalized patients undergoing computed tomography. Am J Kidney Dis 2012;60:74-81.
36.
Colpaert K, Hoste EA, Steurbaut K, Benoit D, Van Hoecke S, De Turck F, Decruyenaere J: Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class. Crit Care Med 2012;40:1164-1170.
37.
Wilson FP, Shashaty M, Testani J, Aqeel I, Borovskiy Y, Ellenberg SS, Feldman HI, Fernandez H, Gitelman Y, Lin J, Negoianu D, Parikh CR, Reese PP, Urbani R, Fuchs B: Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. Lancet 2015;385:1966-1974.
38.
Horne KL, Selby NM: Recent developments in electronic alerts for acute kidney injury. Curr Opin Crit Care 2015;21:479-484.
39.
Ad-hoc working group of ERBP; Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, Van Biesen W: A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012;27:4263-4272.
40.
James M, Bouchard J, Ho J, Klarenbach S, LaFrance JP, Rigatto C, Wald R, Zappitelli M, Pannu N: Canadian Society of Nephrology commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 2013;61:673-685.
41.
Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, Tolwani AJ, Waikar SS, Weisbord SD: KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 2013;61:649-672.
42.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-818.
43.
Ponce D, Berbel MN, Abrao JM, Goes CR, Balbi AL: A randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients. Int Urol Nephrol 2013;45:869-878.
44.
Gabriel DP, Caramori JT, Martim LC, Barretti P, Balbi AL: High volume peritoneal dialysis vs daily hemodialysis: a randomized, controlled trial in patients with acute kidney injury. Kidney Int Suppl 2008;108:S87-S93.
45.
Chionh CY, Soni SS, Finkelstein FO, Ronco C, Cruz DN: Use of peritoneal dialysis in AKI: a systematic review. Clin J Am Soc Nephrol 2013;8:1649-1660.
46.
Mehta RL, McDonald B, Gabbai F, Pahl M, Farkas A, Pascual MT, Zhuang S, Kaplan RM, Chertow GM: Nephrology consultation in acute renal failure: does timing matter? Am J Med 2002;113:456-461.
47.
Costa e Silva VT, Liano F, Muriel A, Diez R, de Castro I, Yu L: Nephrology referral and outcomes in critically ill acute kidney injury patients. PLoS One 2013;8:e70482.
48.
Ponce D, Zorzenon Cde P, dos Santos NY, Balbi AL: Early nephrology consultation can have an impact on outcome of acute kidney injury patients. Nephrol Dial Transplant 2011;26:3202-3206.
49.
Harel Z, Wald R, Bargman JM, Mamdani M, Etchells E, Garg AX, Ray JG, Luo J, Li P, Quinn RR, Forster A, Perl J, Bell CM: Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int 2013;83:901-908.
50.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365-3370.
51.
Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM: Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol 2006;17:1143-1150.
52.
Paquette F, Bernier-Jean A, Brunette V, Ammann H, Lavergne V, Pichette V, Troyanov S, Bouchard J: Acute kidney injury and renal recovery with the use of aminoglycosides: a large retrospective study. Nephron 2015;131:153-160.
53.
Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire F, Brochard L: Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 2001;357:911-916.
54.
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA; CHEST Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012;367:1901-1911.
55.
Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL: Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 2009;76:422-427.
56.
Hoste EA, Schurgers M: Epidemiology of acute kidney injury: how big is the problem? Crit Care Med 2008;36:S146-S151.
57.
Heung M, Steffick DE, Zivin K, Gillespie BW, Banerjee T, Hsu CY, Powe NR, Pavkov ME, Williams DE, Saran R, Shahinian VB; Centers for Disease Control and Prevention CKD Surveillance Team: Acute kidney injury recovery pattern and subsequent risk of CKD: an analysis of Veterans Health Administration data. Am J Kidney Dis 2015, Epub ahead of print.
58.
Thakar CV, Christianson A, Himmelfarb J, Leonard AC: Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol 2011;6:2567-2572.
59.
Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE: The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 2011;79:1361-1369.
60.
Coca SG, Singanamala S, Parikh CR: Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012;81:442-448.
61.
Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, Ray JG: Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 2009;302:1179-1185.
62.
Triverio PA, Martin PY, Romand J, Pugin J, Perneger T, Saudan P: Long-term prognosis after acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant 2009;24:2186-2189.
63.
Chawla LS, Kimmel PL: Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 2012;82:516-524.
64.
Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA: Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transplant 2008;23:1970-1974.
65.
Brandt MM, Falvo AJ, Rubinfeld IS, Blyden D, Durrani NK, Horst HM: Renal dysfunction in trauma: even a little costs a lot. J Trauma 2007;62:1362-1364.
66.
Kerr M, Bedford M, Matthews B, O'Donoghue D: The economic impact of acute kidney injury in England. Nephrol Dial Transplant 2014;29:1362-1368.
67.
Manns B, Doig CJ, Lee H, Dean S, Tonelli M, Johnson D, Donaldson C: Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 2003;31:449-455.
68.
Berbece AN, Richardson RM: Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal. Kidney Int 2006;70:963-968.
69.
Vitale C, Bagnis C, Marangella M, Belloni G, Lupo M, Spina G, Bondonio P, Ramello A: Cost analysis of blood purification in intensive care units: continuous versus intermittent hemodiafiltration. J Nephrol 2003;16:572-579.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.