The global epidemiology of acute kidney injury: challenges and opportunities

Acute kidney injury (AKI) is a devastating complication of acute illness that affects adults and children across multiple settings worldwide and is associated with the development and progression of chronic kidney disease, increased mortality and increased resource utilization. Over the past two decades, standardization of criteria for AKI diagnosis and staging and the publication of multicentre studies have led to improved understanding of the AKI spectrum and provided insights into the heterogeneity of patient characteristics, processes of care and the environmental and sociodemographic factors that influence care delivery and outcomes. Substantial advances have been made in the utilization of electronic health records, biomarkers and care bundles - structured sets of evidence-based treatment practices - to improve the clinical management of AKI. The emerging fields of artificial intelligence and digital health may also provide ways to reduce the burden of this disease. However, these developments have occurred mainly in high-income countries and have yet to improve care delivery or outcomes in low-resource regions. Progress in the development of specific treatments for AKI is limited, and important gaps in knowledge and clinical practice remain, particularly in relation to the 5R framework (risk, recognition, response, renal support and rehabilitation) for managing AKI. An urgent need exists to address the wide variation and inequities in AKI management worldwide.