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  • Review Article
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The contrasting characteristics of acute kidney injury in developed and developing countries

Abstract

Acute kidney injury (AKI) has become increasingly prevalent in both developed and developing countries, and is associated with severe morbidity and mortality, especially in children. Uncertainty regarding the true incidence of AKI limits awareness of the problem, thereby reducing political visibility of the disorder and hampering efforts to prevent its occurrence. In developed countries, AKI occurs predominantly in urban intensive care units and is associated with multiorgan failure and sepsis, high mortality, and occurrence in older populations. While cases of AKI in urban areas of the developing world have similar characteristics to those in the developed world, AKI in rural regions commonly develops in response to a single disease and specific conditions (e.g. gastroenteritis) or infections (e.g. severe malaria, leptospirosis, or hemolytic–uremic syndrome) and in younger otherwise healthy individuals. Many causes of AKI in rural settings, such as diarrhea, poisoning, malaria, or septic abortion, can be prevented by interventions at the individual, community, and regional levels. Treatment with dialysis is often unavailable or too costly in developing regions, so there must be community-wide efforts to eradicate causes of AKI, expedite diagnosis, and aggressively manage prerenal conditions and specific infections. We have reviewed recent literature on AKI, identified differences and similarities in the condition between developed and developing areas, analyzed the practical implications of the identified differences, and made evidence-based recommendations for study and management.

Key Points

  • Acute kidney injury (AKI) is becoming increasingly prevalent, but uncertainty regarding its true incidence limits awareness, reduces the political visibility of the disorder, and hampers efforts to prevent its occurrence

  • AKI in the developing world occurs in both urban and rural areas and often affects younger individuals who have a single disease; volume-responsive renal failure or obstetric complications, infections or toxins are the main mechanisms of renal injury

  • AKI is often the primary cause of chronic kidney disease in the developing world, which increases demand for dialysis and transplantation

  • As renal replacement therapies are often unavailable or unaffordable, community-wide efforts must eradicate causes, expedite diagnosis, and aggressively manage reversible conditions and specific infections that cause severe renal injury

  • AKI in developing countries can be prevented by interventions at the individual, national, and regional levels

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Acknowledgements

The authors gratefully acknowledge the invaluable collaboration of Anne Marie L'Hommedieu, MLS, and Sue Lahey, MLS, from the Schaffer Library of Health Sciences at the Albany Medical College, and of Kim Mitchell, MLS, currently at the George and Leona Lewis Library at the Albany College of Pharmacy, without whose help the development of the search strategy and document retrieval would not have been possible.

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Cerdá, J., Bagga, A., Kher, V. et al. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Rev Nephrol 4, 138–153 (2008). https://doi.org/10.1038/ncpneph0722

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