title: Changing epidemiology of community-acquired acute kidney injury in developing countries: analysis of 2405 cases in 26 years from eastern India.
abstract: BACKGROUND
  The epidemiology of acute kidney injury (AKI) differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India.
  
  
  METHODS
  This study aimed at describing changes in epidemiology of community-acquired AKI (CAAKI) over a time span of 26 years in two study periods, namely, 1983-95 and 1996-2008.
  
  
  RESULTS
  We studied 2405 (1375 male and 1030 female) cases of AKI in the age range 1-95 (mean: 40.32) years. The incidence of CAAKI in 1983-95 and 1996-2008 was 1.95 and 4.14 per 1000 admission, respectively (P < 0.01). Obstetrical AKI has decreased because of the declining number of post-abortal AKI. Surgical AKI decreased from 13.8% in 1983-95 to 9.17% in 1996-2008(P < 0.01). Malarial AKI increased significantly from 4.7% in the first half of the study to 17% in the later period (P < 0.01). Diarrhea-associated AKI had significantly decreased from 36.83% in 1983-95 to 19% in 1996-2008 (P < 0.01). Sepsis-related AKI had increased from 1.57% in 1983-95 to 11.43% in 1996-2008 (P < 0.01). Nephrotoxic AKI showed an increasing trend in recent years (P < 0.01) and mainly caused by rifampicin and NSAIDs. Liver disease-related AKI increased from 1.73% in 1983-95 to 3.17% in 1996-2008 (P < 0.01). Myeloma-associated acute renal failure (ARF) accounted for 1.25% of the total number of ARF cases in the period 1996-2008. HIV infection contributed to 1.65% of ARF of the total number of AKI cases in the second period (1996-2008). Incidence of renal cortical necrosis (RCN) decreased significantly from 5.8% in 1983-95 to 1.3% in 1996-2008 of the total number of ARF cases (P < 0.01). However, during the same period ARF due to acute tubular necrosis, acute glomerulonephritis and acute interstitial nephritis remained unchanged. The mortality rate from AKI decreased significantly from 20% in 1983-95 to 10.98% in 1996-2008 (P < 0.01).
  
  
  CONCLUSIONS
  The epidemiological characteristics of CAAKI have changed over the past three decades. There has been an increase in the overall incidence of ARF with the changing etiology of AKI in recent years. Incidences of obstetrical, surgical and diarrheal AKI have decreased significantly, whereas those of AKI associated with malaria, sepsis, nephrotoxic drugs and liver disease have increased. RCN has decreased significantly. In contrast to developed nations, community-acquired AKI is more common in developing countries. It often affects younger individuals and is caused by single and preventable diseases.
authors.affiliation: Department of Nephrology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Jai
authors.initials: J
authors.lastname: Prakash
authors.affiliation: Department of Nephrology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Takhellambam Brojen
authors.initials: TB
authors.lastname: Singh
authors.affiliation: Department of Nephrology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Biplab
authors.initials: B
authors.lastname: Ghosh
authors.affiliation: Department of Nephrology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Malhotra
authors.affiliation: Department of Nephrology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Surendra Singh
authors.initials: SS
authors.lastname: Rathore
authors.affiliation: Department of Nephrology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Rubina
authors.initials: R
authors.lastname: Vohra
authors.affiliation: Department of Community Medicine , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Rabindra Nath
authors.initials: RN
authors.lastname: Mishra
authors.affiliation: Department of Medicine , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Srivastava
authors.affiliation: Department of Pathology , Institute of Medical Sciences , Banaras Hindu University , Varanasi, Uttar Pradesh , India.
authors.lastname: Usha
keywords: acute kidney injury; changing epidemiology; community-acquired AKI; hospital-acquired AKI; mortality