Abstract: FR-PO066

Spectrum of AKI in Patients from Low Income Countries Participating in the ISN0by25 Initiative

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Macedo, Etienne, UCSD, San Diego, California, United States
  • Sharma, Sanjib Kumar, B P Koirala Institute of Health Sciences, Dharan, Nepal
  • Hemmila, Ulla, College of Medicine, Malawi, Kokemäki, Finland
  • Claure-Del Granado, Rolando, Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia, Plurinational State of
  • Cerda, Jorge, Albany Medical College, Albany, New York, United States
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Mehta, Ravindra L., University of California San Diego Medical Center, San Diego, California, United States
Background

The ISN0by25 Pilot Project is designed to evaluate the effects of an education and training program, point of care (POC) test and teleconsultation on the detection and management of AKI in low resource settings with the goal of reduce preventable deaths from AKI.

Methods

Study consist of 3 phases: observation, education, training and intervention over 1year. In the observation phase, patients presenting at a health care center (HCC) or hospital ER with signs and symptoms associated with moderate/high AKI risk underwent a serum creatinine (sCR) POC test and a urine dipstick. We assessed progression of AKI, need for RRT, hospitalization, mortality and kidney recovery at 7days, 1, 3 and 6 mo, and compared patient characteristics, management and outcomes.

Results

Of 851 adults enrolled, pt characteristics were different within the 3 countries (Table 1). Dehydration as an AKI risk factor was present in>85% of pts enrolled in Bolivia and Nepal, but only in 38% in Malawi. AKI was diagnosed at enrollment in 48%: 42% KDIGO AKI stage1, 20% stage2 and 38% stage3. Of 778 pts with discharge information, 35% were admitted to the hospital and 55% were observed in a HCC for a maximum of 24 hrs. 58% of patients received PO fluids, 62% IV fluids, 10% diuretics, and 2.7% were dialyzed. Mortality at discharge was 4.3% and increased to 10% at 3 mo. AKI pts had higher mortality rate at discharge (AKI 6% vs. non-AKI 2.5%, p=0.02) and at 3 mo (AKI 13% vs non-AKI 6%, p<0.001).

Conclusion

Risk factors for AKI varied according to the region and local health care delivery. Frequency of AKI and hospitalization were high in patients with high AKI risk across these low resource settings. sCR POC test helped to identify patients with higher risk for worse outcomes. This ongoing study will help to understand the profile of preventable deaths from AKI around the globe.

Patient characteristics.
 Bolivia (157)Malawi (316)Nepal (378)
Age (y)60(43-74)38(30-52)53(35-65)
Comorbidities (%)
Hypertension36(23)38(12)125(33)
DM31(20)24(7)62(16)
HIV0140(44)2(0.5)
Anemia15(10)49(15)29(8)
CKD18(11)1(0.3)6(1.6)

Values represent median (interquartile range) or number (proportion)

Funding

  • Private Foundation Support