Poisons causing acute kidney injury in Indo-Pak region: A meta-analysis

To systematically review relevant literature to assess the extent of acute kidney injury problems as a result of exposure to different poisons in subcontinental settings.

The Meta-Analysis was conducted in April 2025, and comprised search on PubMed, Cochrane Library, Web of Science, Embase, PubMed Central and Google Scholar databases for relevant literature related to Pakistan and India using key words and medical subjects' headings in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines. After removal of duplicates and irrelevant articles, quality was assessed using Newcastle Ottawa Scale. R studio was used for analysis, while forest plot was applied using both fixed and random effect models for all-group mortality and sub-group analysis for paraphenylene diamine poisoning. Publication bias was evaluated using funnel plot asymmetry, Egger's regression test, and Begg's rank correlation test.

Of the 19 studies analysed, 12(63.2%) were from India and 7(36.8%) were from Pakistan. The overall patient population was 3,769. Of the total, 10(52.6%) studies only addressed paraphenylene diamine poisoning, 1(5.3%) one each focussed on paraquat, organophosphate, copper sulphate, methyl alcohol and rodenticides, and the rest comprised multiple substances. There was wide heterogeneity and publication bias among the studies [I2(90%)]. A pooled mortality of 20-23%, with fixed and random-effect model estimates being 0.23 (95% confidence interval: 0.22-0.25) and 0.20 (95% confidence interval: 0.12-0.28), respectively. Heterogeneity I2 of 90% was observed.

A number of cheap and easily available substances could cause poisoning and systemic harmful effects, including single- or multi-organ failure. Extent of morbidity and rate of mortality varied widely with multiple co-factors, while wide heterogeneity required more focussed and detailed publications on the subject.