title: A Prospective International Multicenter Study of AKI in the Intensive Care Unit.
abstract: OBJECTIVE
  AKI is frequent and is associated with poor outcomes. There is limited information on the epidemiology of AKI worldwide. This study compared patients with AKI in emerging and developed countries to determine the association of clinical factors and processes of care with outcomes.
  
  
  METHODS
  This prospective observational study was conducted among intensive care unit patients from nine centers in developed countries and five centers in emerging countries. AKI was defined as an increase in creatinine of ≥0.3 mg/dl within 48 hours.
  
  
  RESULTS
  Between 2008 and 2012, 6647 patients were screened, of whom 1275 (19.2%) developed AKI. A total of 745 (58% of those with AKI) agreed to participate and had complete data. Patients in developed countries had more sepsis (52.1% versus 38.0%) and higher Acute Physiology and Chronic Health Evaluation (APACHE) scores (mean±SD, 61.1±27.5 versus 51.1±25.2); those from emerging countries had more CKD (54.3% versus 38.3%), GN (6.3% versus 0.9%), and interstitial nephritis (7.0% versus 0.6%) (all P<0.05). Patients from developed countries were less often treated with dialysis (15.5% versus 30.2%; P<0.001) and started dialysis later after AKI diagnosis (2.0 [interquartile range, 0.75-5.0] days versus 0 [interquartile range, 0-5.0] days; P=0.02). Hospital mortality was 22.0%, and 13.3% of survivors were dialysis dependent at discharge. Independent risk factors associated with hospital mortality included older age, residence in an emerging country, use of vasopressors (emerging countries only), dialysis and mechanical ventilation, and higher APACHE score and cumulative fluid balance (developed countries only). A lower probability of renal recovery was associated with residence in an emerging country, higher APACHE score (emerging countries only) and dialysis, while mechanical ventilation was associated with renal recovery (developed countries only).
  
  
  CONCLUSIONS
  This study contrasts the clinical features and management of AKI and demonstrates worse outcomes in emerging than in developed countries. Differences in variations in care may explain these findings and should be considered in future trials.
authors.affiliation: Department of Medicine, University of Montreal, Montréal, Québec, Canada;
authors.forename: Josée
authors.initials: J
authors.lastname: Bouchard
authors.affiliation: Department of Medicine, Jacobi Medical Center, New York, New York;
authors.forename: Anjali
authors.initials: A
authors.lastname: Acharya
authors.affiliation: Albany Medical College, Albany, New York;
authors.forename: Jorge
authors.initials: J
authors.lastname: Cerda
authors.affiliation: Department of Medicine, Quinta D'Or Hospital, Rio de Janeiro, Brazil;
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Maccariello
authors.affiliation: Department of Medicine, CARE Hospitals, Banjara Hills, Hyderabad, India;
authors.forename: Rajasekara Chakravarthi
authors.initials: RC
authors.lastname: Madarasu
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
authors.forename: Ashita J
authors.initials: AJ
authors.lastname: Tolwani
authors.affiliation: Department of Medicine, Guangdong General Hospital, Guangzhou, China;
authors.forename: Xinling
authors.initials: X
authors.lastname: Liang
authors.affiliation: Department of Medicine, West China School of Medicine Sichuan University, Chengdu, Sichuan, China;
authors.forename: Ping
authors.initials: P
authors.lastname: Fu
authors.affiliation: Department of Medicine, Jinling Hospital, Nanjing University, Nanjing, China; and.
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
authors.affiliation: Department of Medicine, University of California at San Diego, San Diego, California rmehta@ucsd.edu.
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D002681:China; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D003906:Developing Countries; D005060:Europe; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007194:India; D007362:Intensive Care Units; D007668:Kidney / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009656:North America; D011446:Prospective Studies; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012111:Residence Characteristics; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: acute renal failure; epidemiology and outcomes; nephrology