PLoS ONE (Jan 2019)

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

  • Raúl Lombardi,
  • Alejandro Ferreiro,
  • Rolando Claure-Del Granado,
  • Emmanuel A Burdmann,
  • Guillermo Rosa-Diez,
  • Luis Yu,
  • Mauricio Younes-Ibrahim,
  • Cristina Carlino,
  • Jonathan S Chávez-Iñiguez,
  • Mariana B Pereira,
  • Carlos F Varela,
  • Welder Zamoner,
  • Diego Janiques,
  • Soledad Lecueder,
  • Víctor Cerrón-Millán,
  • Alfonso Cueto-Manzano,
  • EPILAT-ITA Study Group

DOI
https://doi.org/10.1371/journal.pone.0224655
Journal volume & issue
Vol. 14, no. 11
p. e0224655

Abstract

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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.