World Incidence of AKI: A Meta-Analysis
World Incidence of AKI: A Meta-Analysis
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DOI：
10.2215/cjn.00710113
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发表时间：
2013-09-06
影响因子：
9.8
通讯作者：
Jaber, Bertrand L.
中科院分区：
文献类型：
--
作者：
Susantitaphong, Paweena;Cruz, Dinna N.;Jaber, Bertrand L.
背景和目的全球AKI的负担尚未得到系统的研究。设计、设置、参与者和测量对大型队列研究进行了系统回顾(2004-2012)，以估计全球AKI的发病率及其严重程度和相关死亡率，并描述不同国家、地区和经济的地理差异。AKI的定义根据肾脏疾病改善全球预后(KDIGO)分期系统进行了重新分类。结果共发现312项研究(n=49,147,878)，主要集中在医院环境中。大多数研究来自北美、北欧和东亚，来自高收入国家，以及将国内生产总值的5%用于总卫生支出的国家。在采用KDIGO等值AKI定义的154项研究中(n=3,585,911)，成人AKI的合并发病率为21.6%(95%可信区间[95%CI]，19.3~24.1)，儿童AKI的合并发病率为33.7%(95%CI，26.9~41.3)。合并AKI相关死亡率成人为23.9%(95%CI，22.1~25.7)，儿童为13.8%(95%CI，8.8~21.0)。AKI相关死亡率随着时间的推移而下降，并且与国家的收入和国内生产总值用于医疗总支出的百分比成反比。结论使用KDIGO的定义，全球每5个成年人和1个儿童中就有1人在住院期间经历过AKI。这一分析提供了一个平台，以提高公众、政府官员和卫生保健专业人员对AKI的认识。
Background and objectivesThe burden of AKI around the globe has not been systematically examined.Design, setting, participants, & measurementsA systematic review (2004-2012) of large cohort studies was conducted to estimate the world incidence of AKI and its stages of severity and associated mortality, and to describe geographic variations according to countries, regions, and their economies. AKI definitions were reclassified according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system. Random-effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity.ResultsThere were 312 studies identified (n=49,147,878) , primarily in hospital settings. Most studies originated from North America, Northern Europe, and Eastern Asia, from high-income countries, and from nations that spent 5% of the gross domestic product on total health expenditure. Among the 154 studies (n=3,585,911) that adopted a KDIGO-equivalent AKI definition, the pooled incidence rates of AKI were 21.6% in adults (95% confidence interval [95% CI], 19.3 to 24.1) and 33.7% in children (95% CI, 26.9 to 41.3). The pooled AKI-associated mortality rates were 23.9% in adults (95% CI, 22.1 to 25.7) and 13.8% in children (95% CI, 8.8 to 21.0). The AKI-associated mortality rate declined over time, and was inversely related to income of countries and percentage of gross domestic product spent on total health expenditure.ConclusionsUsing the KDIGO definition, 1 in 5 adults and 1 in 3 children worldwide experience AKI during a hospital episode of care. This analysis provides a platform to raise awareness of AKI with the public, government officials, and health care professionals.