The ISN 0by25 global snapshot study

Abstract

The International Society of Nephrology's (ISN) 0by25 initiative aims to prevent avoidable deaths from acute kidney injury (AKI) by 2025, most of which occur in low and lower middle-income countries (LLMICs). To increase evidence about the epidemiology of AKI, especially in LLMICs, ISN conducted a 'Global Snapshot', a multinational, cross-sectional study in which 322 physicians from 72 countries in 6 continents identified 3,664 adults and 354 children with AKI who were under their care of which 45% were from LLMICs, nevertheless low-income countries were under-represented. In LLMICs, patients with AKI were younger, and community acquired AKI was more common. Hypotension (40%) and dehydration (39%) were the most common causes of AKI. Dehydration was a more common cause in LLMIC, as were sepsis, pregnancy-related AKI and animal envenomation. Acute dialysis was performed in 23% of patients. Eight percent had a clinical indication for this but were not dialyzed. In LLMICs, lack of resources (16%) and inability to afford therapy (30%) accounted for almost half of these cases. Overall mortality at 7 days was 11% and was higher in LLMICs. Complete recovery from AKI occurred in 30% of patients and partial recovery 37%, and was more often complete in LLMICs. The 0by25 Global Snapshot provides new information about the worldwide epidemiology of AKI, helping to identify elements that would be amenable in intervention to reduce preventable deaths.