title: Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review.
abstract: BACKGROUND
  Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care.
  
  
  METHODS
  We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690.
  
  
  RESULTS
  We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex.
  
  
  CONCLUSIONS
  Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa.
  
  
  BACKGROUND
  None.
authors.affiliation: Paediatric Nephrology and Hypertension Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria.
authors.forename: Wasiu A
authors.initials: WA
authors.lastname: Olowu
authors.affiliation: Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Senegal.
authors.forename: Abdou
authors.initials: A
authors.lastname: Niang
authors.affiliation: Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Osafo
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine & Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ashuntantang
authors.affiliation: Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria.
authors.forename: Fatiu A
authors.initials: FA
authors.lastname: Arogundade
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Porter
authors.affiliation: Department of Internal Medicine and Nephrology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Saraladevi
authors.initials: S
authors.lastname: Naicker
authors.affiliation: Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland. Electronic address: valerie.luyckx@uzh.ch.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Luyckx
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D011203:Poverty; D006435:Renal Dialysis / Q000191:economics