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Changing epidemiology and outcomes of acute kidney injury in Brazilian patients: a retrospective study from a teaching hospital

  • Nephrology - Original Paper
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Abstract

Purpose

While considerable information is available on acute kidney injury (AKI) in North America and Europe, large comprehensive epidemiologic studies on AKI from Latin America and Asia are still lacking. The present study aimed to evaluate the epidemiology and outcomes of AKI in patients evaluated by nephrologists in a Brazilian teaching hospital.

Methods

We performed a large retrospective observational study that looked into the epidemiology of AKI and its effect on patient outcomes across time periods. For comparison purposes, patients were divided into two groups according to the year of follow up: 2011–2014 and 2015–2018.

Results

We enrolled 7976 AKI patients and, after excluding patients with chronic kidney disease stages 4 and 5, kidney transplant recipients and those with incomplete data, 5428 AKI patients were included (68%). The maximum AKI stage was 3 (50.6%), and there was a mortality rate of 34.3% (1865 patients). Dialysis treatment was indicated in 928 patients (17.1%). Patient survival improved along the study periods, and patients treated in 2015–2018 had a relative risk death reduction of 0.89 (95% CI 0.81–0.98, p = 0.02). The independent risk factors for mortality were sepsis, > 65 years of age, admission to the intensive care unit, AKI-KDIGO 3, recurrent AKI, no metabolic and fluid demand to capacity imbalance (as a dialysis indication), and the period of treatment.

Conclusion

We observed an improvement in AKI patient survival over the years, even after correction for several confounders and using a competing risk approach. Identification of risk factors for mortality can help in decision-making for timely intervention, leading to better clinical outcomes.

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Data availability statement

The data used to support the findings of this study can be included within the supplementary information file.

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Acknowledgements

We would like to thank the nurses of the Dialysis Unit of Clinical Hospital from UNESP, Botucatu, Brazil.

Funding

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) supported this study.

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Authors and Affiliations

  1. Botucatu School of Medicine, UNESP, Botucatu, Brazil

    Daniela Ponce, Welder Zamoner, Marci Maira Batistoco & André Balbi

  2. Clinical Hospital of Botucatu Medical School, Botucatu, Brazil

    Daniela Ponce, Welder Zamoner, Marci Maira Batistoco & André Balbi

Authors
  1. Daniela Ponce
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  2. Welder Zamoner
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  3. Marci Maira Batistoco
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  4. André Balbi
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Contributions

WZ and MB collected the data. DP and WZ performed statistical analysis. DP and WZ wrote the main manuscript text. DP and ALB reviewed the final version of the paper.

Corresponding author

Correspondence to Daniela Ponce.

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Conflict of interest

The authors declare there are no competing financial or non-financial interests. We agree with it.

Statement of ethics

We confirm that all methods carried out were in accordance with relevant guidelines and regulations from Botucatu Medical School. The research project was approved by the Ethics Committee of Botucatu Medical School in June 2012 (IRB approval number 0641/012). Free and informed consent was given in writing by each patient or their relatives before the start of the study procedures.

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Ponce, D., Zamoner, W., Batistoco, M.M. et al. Changing epidemiology and outcomes of acute kidney injury in Brazilian patients: a retrospective study from a teaching hospital. Int Urol Nephrol 52, 1915–1922 (2020). https://doi.org/10.1007/s11255-020-02512-z

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  • DOI: https://doi.org/10.1007/s11255-020-02512-z

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