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Tan J, Liew A, Koh D. Clinical outcomes and performance indicators of patients with Kidney Failure and Acute Kidney Injuries in ASEAN countries. Nephrology (Carlton) 2022; 27:739-752. [PMID: 35661340 DOI: 10.1111/nep.14070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This review article reports clinical outcomes and performance indicators of patients with Kidney Failure (KF) and Acute Kidney Injuries (AKI) in Association of South East Asian Nations (ASEAN) countries. METHODOLOGY ASEAN data, segregated by income status, from national registries and literature were collated, compared and benchmarked against international references. RESULTS The national incidence and prevalence of treated KF ranged from 172-479 per million population (pmp) and 36-2255 pmp respectively. Brunei (79%), Malaysia (66%) and Singapore (66%) had world-leading proportions of diabetes-related KF. Haemodialysis (HD), Peritoneal Dialysis (PD) and transplant accounted for 68-100%, 0-27% and 0-18% of all Kidney Failure Replacement Therapy respectively. Transplant patient survival were superior with 90-93% at five years and 71-90% at 10 years, compared to PD (44-54%) and HD (53-64%) at five years. Higher-income countries were able to achieve good anaemia control, HD and PD adequacy targets, whilst usage of arteriovenous fistula in HD varied from 70-85%. Acute Kidney Injury (AKI) rates ranged from 24.2-49.2% of high-dependency admissions. Lower incidences of PD peritonitis and HD Catheter-related Bloodstream Infections; and PD-favouring quality-of-life were evident in higher-income countries. CONCLUSION ASEAN has a challenging burden of kidney disease, with extremely high incidence, prevalence, DM-related KF and AKI rates. The magnitude of the prevailing problem calls for the creation of a regional society under the auspices of ASEAN with a shared perspective of universal, equitable and charitable access to quality renal care; consistent with the founding premises and healthcare initiatives of ASEAN. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jackson Tan
- Department of Nephrology, Ripas Hospital / Universiti Brunei Darussalam, Brunei Darussalam
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - David Koh
- NUS Saw Swee Hock School of Public Health, Singapore
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Bai ZH, Guo XQ, Dong R, Lei N, Pei HH, Wang H. A Nomogram to Predict the 28-day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy. Am J Med Sci 2020; 361:607-615. [PMID: 33288206 DOI: 10.1016/j.amjms.2020.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/27/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a severe and common complication in critically ill patients and is associated with increased morbidity and mortality. At present, there is not a tool to predict the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT). METHODS A retrospective cohort study was to construct a prediction model for the 28-day mortality of patients with AKI and treated with CRRT. From January 2009 to September 2016, A total of 846 cases were included in our study. RESULTS A total of five variables selected by multi-factor Cox regression analysis were used to constructed three predictive models and adopted bootstrapping for internal validation. Finally, we get five sets of models (three sets of construction models and two sets of internal verification models) with similar predictive value. The stepwise model, which including four variables (CCI score, Alb, Phosphate (24h) and SOFA score), was the simplest model, so we chose it as our final predictive model and constructed a nomogram based on it. The area under the ROC curve (AUC) of the stepwise model and the stepwise bootstrap model (BS stepwise) were respectively 0.78(0.75,0.82) and 0.78 (0.75,0.82). The AUC of the stepwise model and the BS stepwise in patients with sepsis were 0.77 (0.73,0.81) and 0.77 (0.73,0.81). The AUC of the stepwise model and the BS stepwise in patients without sepsis were 0.83 (0.78,0.89) and 0.83 (0.78,0.89). CONCLUSIONS We developed a four-marker-based prognostic tool that could effectively predict each individual's 28-day mortality for patients with AKI and treated with CRRT.
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Affiliation(s)
- Zheng-Hai Bai
- Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Xiao-Qing Guo
- Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Rong Dong
- Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Na Lei
- Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Hong Hong Pei
- Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China.
| | - Hai Wang
- Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China.
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Srisawat N, Kulvichit W, Mahamitra N, Hurst C, Praditpornsilpa K, Lumlertgul N, Chuasuwan A, Trongtrakul K, Tasnarong A, Champunot R, Bhurayanontachai R, Kongwibulwut M, Chatkaew P, Oranrigsupak P, Sukmark T, Panaput T, Laohacharoenyot N, Surasit K, Keobounma T, Khositrangsikun K, Suwattanasilpa U, Pattharanitima P, Santithisadeekorn P, Wanitchanont A, Peerapornrattana S, Loaveeravat P, Leelahavanichkul A, Tiranathanagul K, Kerr SJ, Tungsanga K, Eiam-Ong S, Sitprija V, Kellum JA. The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study. Nephrol Dial Transplant 2019; 35:1729-1738. [DOI: 10.1093/ndt/gfz087] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand.
Methods
We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI.
Results
We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development.
Conclusions
In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.
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Affiliation(s)
- Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Win Kulvichit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Noppathorn Mahamitra
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Cameron Hurst
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anan Chuasuwan
- Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Konlawij Trongtrakul
- Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Adis Tasnarong
- Department of Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - Ratapum Champunot
- Department of Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Rangsun Bhurayanontachai
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Prince Songkla University, Songkla, Thailand
| | - Manasnun Kongwibulwut
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pornlert Chatkaew
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | | | | | | - Sadudee Peerapornrattana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Passisd Loaveeravat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Visith Sitprija
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand
| | - John A Kellum
- Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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