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

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          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

          Blood Purif
          Blood Purification
          S. Karger AG
          July 2020
          22 January 2020
          : 49
          : 4
          : 386-393
          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
          505568 Blood Purif 2020;49:386–393
          © 2020 S. Karger AG, Basel

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


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