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Disclosure of Interest
NORBERT H. LAMEIRE

No interest conflicts to declare

The details of each Disclosure of Interest are available at the Invited Speakers desk (located
in the Registration Area).

Global epidemiology of
acute kidney injury
Norbert Lameire, MD, PhD
Em Prof of Medicine
University Hospital
Gent, Belgium

ERA/EDTA Congress London 2015

Competing epidemics of kidney

diseases in the USA
Disease incidence, 2003
per million person years

ESRD (requiring dialysis) 343 ( 0-1 % per year)

AKI (requiring dialysis)

295 ( > 7% per year)

Modified from Hsu C-Y, J Am Soc Nephrol, 21: 1607-1611, 2010

Annual
mortality
rate

24 %

> 28 %

Population incidence of dialysisrequiring AKI in the United States from

2000 to 2009

Hsu et al, J Am Soc Nephrol 24: 3742, 2013

Incidence and Outcomes in AKI:

A European Population-Based Study
Scotland (UK)

Ali et al, J Am Soc Nephrol 18: 12921298, 2007

AKI :RIFLE definition

Epidemiology, outcome community- vs

hospital acquired AKI two district hospitals- Wales (UK)
Study timing

July 11, 2011,-January 15, 2012

Total number admitted

Total AKI

15976
1020 (6.4%)

Community-acquired (CA-AKI)

4.3%

Hospital acquired (HA-AKI)

2.1%

Pre-existing CKD

31.9 %

Mortality CA-AKI

45 %

Mortality HA-AKI

62.9 %

Referral to nephrologists

8.3 %

Wonnacott et al, Clin J Am Soc Nephrol 9: cccccc, 2014

Epidemiology of AKI (East Kent, UK)

All adult patients (18 years or over) admitted between 1st February 2009
and 31st July 2009
15325

PMP/Yr

10534

2772

Total

AKIN 1

Bedford et al. BMC Nephrology 2014, 15:95

AKIN 2

2020
AKIN 3

Mean age in AKI population in East Kent

All adult patients (18 years or over) admitted between 1st February 2009 and
31st July 2009

74.2

76.1

72.5

Years

62

Non AKI

AKIN1

Bedford et al. BMC Nephrology 2014, 15:95

AKIN2

AKIN3

Kaplan-Meier patient survival by AKI in East Kent

Bedford et al. BMC Nephrology 2014, 15:95

Variation in Risk and Mortality of AKI in Critically Ill

Patients: A Multicenter Study-AKI 6 cohort
(n:15132 pts- age:63yr IQ1,Q3 49.74)

AKI rate
50
45
40
35
30
25
20
15
10
5
0

RRT rate

Mortality rate
43.8

41.9
36.6

31.8
27.3
23.3

12.5
7.2

Center 1

15.7

15.3

14.6

11.712.4

9.5
5.6

5.1

Center 2

Center 3

Center 4

Srisawat et al, Am J Nephrol 2015;41:8188

Center 5

9.2

Center 6

Hospital mortality of AKI according to KDIGO

criteria across centers-AKI 6 cohort
AKI

% 40

non-AKI
35.9

35

32.4
28.8

30
25

23.8

25.1

20.4

20
14.2

15
10

26.5

5.9

6.9

8.9

9.5
6.2

7.9

0
Center 1 Center 2 Center 3 Center 4 Center 5 Center 6
Srisawat et al, Am J Nephrol 2015;41:8188

Total

Raising Awareness AKI Dr Cerda

World Incidence of AKI

Meta-Analysis 2004-2012
Selected 312 publications 50 million subjects
154 studies used KDIGO-equivalent criteria

Top 3 zones: North America, N Europe and E Asia

82% high-income countries
Most studies in countries with a health expenditure
>5% GDP

Susantitaphong, Cerd, Cruz and Jaber

on behalf of the ASN AKI Adv Group. CJASN 2013

Countries of Origin

92.3%
7.7%
Slide from J Cerda

Pooled incidence rate of AKI according to

the KDIGO equivalent definition

Susantitaphong et al, Clin J Am Soc Nephrol 8: 14821493, 2013

FIRST META-ANALYSIS 2004-2012

AKI INCIDENCE BY KDIGO DEFINITION

22%
14.7%
20.1%

24.5%
31.5%

14.7%

16.7%
23.7%

In a large cohort of 50,000,000 individuals, utilizing KDIGO

definitions, 29.6%
1 in 5 adult and 1 in 3 children experienced AKI worldwide
25.6%

Susantitaphong et al CJASN 2013

FIRST META-ANALYSIS 2004-2012

AKI INCIDENCE BY KDIGO DEFINITION

22%
50% STUDIES
5% WORLD
POPULATION

14.7%
20.1%
31.5%

14.7%

16.7%
23.7%

29.6%

2 STUDIES FROM
AFRICA
15% WORLD
POPULATION

25.6%
Very few studies from LMIC, where 85% of the
world
population resides

Susantitaphong et al CJASN 2013

AKI-associated mortality decreased over 8 years and

was inversely related to
country health expenditure and per capita gross
national income

LITERATURE SEARCH
Pubmed, Web of Science
2012-2014
1049 citations

Excluded 549 citations

500 citations
187 papers
Did not meet
meta-analysis criteria
(89,325 subjects)

313 papers
Met meta-analysis
Criteria
(28,618,562 Subjects)

Regional
Analysis

Africa
62 studies
(55,309
Subjects)
Lameire

Asia
92 studies
(26,993
Subjects)
Jha

Lat Amer
33 studies
(7,023
Subjects)

New
Meta-analysis
765 studies
(77.393,454
Subjects)

Garcia-Garcia

Cerda, Susantitahong, Cruz, Jaber

Mehta, Cerd, Burdmann et al, Lancet 2015

Previous
Meta-analysis
2004-2012
452 studies
(48,774,892
Subjects)

Pooled incidence of AKI (KDIGO

definitions) from new meta-analysis

Mehta et al, Lancet published online March 2015

Pooled AKI Incidence Rate

Meta-analysis 2004-2014
11% all AKI

79.9% all AKI

No. studies
No. subjects

266
4,502,158

185
3,586,523

175
3,544,407

178
3,554,167

272
41,511,398
Cerd, Susantitaphong,
Cruz and Jaber for the 0by25 Initiative
World Congress Nephrology 2015

Pooled AKI-Associated Mortality Rate

Meta-analysis 2004-2014
Unadjusted OR of death
12.5
19.7

No. studies
No. subjects with AKI

171
484,279

56
117,467

54
49,850

56
50,108

54
10,612
Cerd, Susantitaphong,
Cruz and Jaber for the 0by25 Initiative
World Congress Nephrology 2015

Incidence and Mortality of AKI By Country

Income
Second Meta-Analysis 2004-2014
REGION BY
INCOME
LMIC
HIC

INCIDENCE AKI
(95% CI)
16.1% (10.0-24.9)
21.9% (19.9-24.1)
*

NUMBER OF
STUDIES
42
215

MORTALITY AKI
(95% CI)
30% (24.0-36.8)
19.3% (17.9-20.8)
**

NUMBER OF
STUDIES
35
136

Incidence and mortality of AKI in meta-analysis studies, distributed by country

income.
LMIC: Low-middle income countries; HIC: High-income countries
* p=0.0644 by unpaired t-test; ** p=0.003 by unpaired t-test

SIMILAR
INCIDENCE

HIGHER
MORTALITY
IN LIMC

Cerd, Susantitaphong,
Cruz and Jaber for the 0by25 Initiative
World Congress Nephrology 2015

Incidence and Mortality of AKI:

REGIONAL ANALYSIS
Lameire, Garcia-Garcia, Jha
INCIDENCE
(PMP)

Mehta, Cerd, Burdmann et al, Lancet 2015

Characteristics of AKI in HIC and LMIC:

New Data
AKI IN HIGH INCOME COUNTRIES

AKI IN LOW-MIDDLE INCOME COUNTRIES

Occurs predominantly in the ICU

Two main patterns:

i.
Small rural health
centers/hospitals
ii.
Big cities big hospitals, ICUs
Often caused by a single disease, multiple
organ failure less common
Frequently associated with
o Specific disease (example diarrhea)
o Specific infection (example malaria)

Associated with multiple organ failure

Associated with sepsis and complex surgery
(major trauma, cardiovascular surgery)
High mortality
A disease of increasingly older populations

Apparently HIGHER mortality

A disease of young, otherwise healthy people

Increasing incidence?
Accurately reported
Difficult to prevent
Very costly to treat

Increasing incidence?
LESS Severely underreported
Eminently preventable
Very inexpensive to treat at early stages,
unaffordable at severe stages