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Acute Kidney Injury After Cardiac Surgery in Low- and Middle-Income Countries
Emmanuel Ndaba1, Vukosi Baloyi1
1Department of Surgery, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Annals of Global Health
|August 1, 2026
Summary
Cardiac surgery-associated acute kidney injury (CSA-AKI) is common globally. While incidence is similar, low- and middle-income countries face higher mortality due to delayed detection and limited renal replacement therapy access.
Area of Science:
- Nephrology
- Cardiology
- Global Health
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant postoperative complication.
- CSA-AKI is linked to increased mortality, extended ICU stays, and high healthcare costs.
- Incidence may appear similar globally, but disparities exist in severity and outcomes between high-income countries (HICs) and low- and middle-income countries (LMICs).
Purpose of the Study:
- To compare CSA-AKI epidemiology, severity, outcomes, and health system determinants across HIC and LMIC settings.
- To identify system-level factors contributing to excess CSA-AKI mortality in resource-limited environments.
Main Methods:
- Focused narrative review of contemporary observational studies on CSA-AKI.
- Searches included PubMed/MEDLINE and reference list hand-searching.
- Prioritized studies using standardized AKI definitions (RIFLE, AKIN, KDIGO) and reporting perioperative outcomes.
Main Results:
- CSA-AKI incidence ranged from 20% to 43% globally.
- LMIC cohorts showed more advanced AKI at diagnosis and significantly higher mortality, especially with renal replacement therapy (RRT).
- HICs had ~1% dialysis-requiring CSA-AKI with high mortality; LMICs reported lower RRT use, delayed initiation, and 40-55% mortality in advanced AKI.
Conclusions:
- CSA-AKI disproportionately impacts resource-limited settings, with severe consequences.
- Excess mortality in LMICs is driven by delayed detection and limited rescue capacity, not solely biological factors.
- Improved perioperative surveillance and timely renal support access can reduce avoidable CSA-AKI mortality.
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