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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Health Care Access, Socioeconomic Status, and Acute Kidney Injury Outcomes: A Prospective National Study
Ali AlSahow1, Omar Alkandari2, Anas AlYousef3
1Division of Nephrology, Jahra Hospital, Al Jahra, Kuwait.
Rationale & Objectives:
Acute kidney injury (AKI) incidence and outcome in Kuwait are unknown. Moreover, non-Kuwaitis, who represent 66% of the population, have lower income, and their access to public health services is restricted compared with Kuwaitis who have free full access.
Study Design:
Observational prospective multicenter cohort study.
Setting & Participants:
Adult inpatients with AKI in 7 public hospitals from January 1 to December 31, 2021.
Exposure:
AKI identified using Kidney Disease: Improving Global Outcomes serum creatinine-based criteria.
Outcomes:
For hospitalized patients with AKI, the outcomes included 30-day outcomes of mortality, need for dialysis, kidney recovery rates, and differences in outcomes between Kuwaitis and non-Kuwaitis.
Analytical Approach:
A backward stepwise multiple logistic regression analysis was performed to assess possible independent risk factors for the outcomes.
Results:
We recruited 3,744 patients (mean age: 63 years; mean baseline estimated glomerular filtration rate [eGFR]: 66.7 mL/min; non-Kuwaitis: 42.3%), representing 3.2% of hospitalizations and 19.5% of intensive care unit (ICU) admissions. Non-Kuwaitis were significantly younger (57.6 vs 66.9 years), with higher baseline eGFR (73.1 vs. 62 mL/min), more frequent community acquired AKI (53.8% vs 46.7%), and AKI in summer (34.7% vs 26.9%). Dialysis was provided to 33.5% of patients, with a higher need for non-Kuwaitis (35.5% vs 32.1%). At 30 days, 34.4% of patients died, representing 24.8% of hospital mortality and 59.8% of ICU mortality. No differences in mortality or kidney recovery were noted between Kuwaitis and non-Kuwaitis. Low eGFR did not affect the mortality rate.
Limitations:
Observational nature and short follow-up period of 30 days only.
Conclusions:
AKI was associated with high dialysis need and mortality. Non-Kuwaitis accounted for less cases despite representing 66% of the population because they were younger with higher baseline eGFR and fewer comorbid conditions. Non-Kuwaitis had higher rates of community acquired AKI and AKI in summer and a higher need for dialysis but had similar mortality and complete kidney recovery rates.
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