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      Correlation between the Incidence and Attributable Mortality Fraction of Acute Kidney Injury: A Systematic Review

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          Abstract

          Introduction: The incidence of acute kidney injury (AKI) as diagnosed by international standardized criteria as well as its mortality has undergone extreme variations. Although AKI is a significant worsening mortality factor, a higher prevalence may lead to better patient management, thereby lowering mortality. We investigated the correlation between AKI incidence and its associated mortality. Methods: We conducted a systematic review of studies on AKI reporting its incidence and mortality. Literature searches were performed in ­MEDLINE, EMBASE, and Cochrane Library, within the time frame of 2004–2018. Studies with small number of participants (<500 for adult cohorts, 50 for pediatric cohorts) were excluded. The correlation among AKI incidence, mortality, and AKI-attributable fraction of mortality was evaluated using a regression model. The trend test was used to analyze the effect of publication year and country gross domestic product (GDP). Results: A total of 4,694 manuscripts were screened, from which 287 cohorts were eligible (adults: 203 cohorts comprising 7,076,459 patients; children: 84 comprising 69,677 patients). Within adult cohorts, AKI patients’ mortality increased ( R<sup>2</sup> = 0.023, β = 0.12, p = 0.03) but the attributable fraction of mortality decreased ( R<sup>2</sup> = 0.27, β = –0.43, p < 0.001) with the increasing AKI incidence. Both more recent publications and higher GDP countries had a lower crude AKI patients’ mortality, although AKI-attributable fraction did not decrease. Conclusions: Cohorts with high AKI incidence had a relatively low AKI-attributable mortality fraction, which suggests an advantage of more experienced AKI management. Further study is needed, however, to address the heterogeneity of included cohorts and to confirm the causality. (Registered in prospective register of systematic reviews database; CRD 42019129322.)

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          Author and article information

          Journal
          BPU
          Blood Purif
          10.1159/issn.0253-5068
          Blood Purification
          S. Karger AG
          0253-5068
          1421-9735
          2020
          July 2020
          22 January 2020
          : 49
          : 4
          : 386-393
          Affiliations
          aDivision of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
          bDepartment of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
          cDepartment of Health Services Research, University of Tsukuba, Tsukuba, Japan
          dDivision of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
          Author notes
          *Kent Doi, MD, PhD, Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655 (Japan), E-Mail kdoi-tky@umin.ac.jp
          Article
          505568 Blood Purif 2020;49:386–393
          10.1159/000505568
          31968336
          © 2020 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Figures: 3, Tables: 1, Pages: 8
          Categories
          Systematic Review

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