Epidemiology and Outcomes of Acute Kidney Injury Among Patients in the Intensive Care Units in Laos: A Nationwide Multicenter, Prospective, and Observational Study

Abstract

Background: Acute kidney injury (AKI) has become a global health issue. Still, little is known about the disease burden in Laos. Thus, we aimed to evaluate the burden and outcomes of AKI as well as assess the availability of diagnosis and treatment in Laos. Methods: We performed a multi-centric prospective observational study in adult patients who had been admitted to 5 intensive care units in Laos. The data was serially collected on the first 28 days of ICU admission by registration in an electronic web-based format. Patients were diagnosed by the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI. We used AKI occurrence as the primary outcome and explored modifiable and non-modifiable risk factors on the development and outcomes of AKI. Findings: We enrolled 1480 patients from 5 ICU centers across Laos from January to December 2016. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 508 of the 1460 enrolled patients (34·8%). Overall, the maximum AKI stage was stage 1 in 4%, stage 2 in 10·3% and stage 3 in 20·5%. The mortality rate was 28·4% in non-AKI patients compared with 44·5% in AKI patients, which increased according to the stage of AKI (stage 1 = 4·9%, stage 2= 28·3%, stage 3= 66·8%, p < 0·001). There were 13·6% who were discharged against medical advice. Interpretation: AKI is a huge burden in Laos with under-recognition and poor outcomes. Funding Statement: The International Society of Nephrology (ISN); Kidney Foundation of Thailand; Medical Association of Thailand. Declaration of Interests: The authors stated: None. Ethics Approval Statement: The study protocol was reviewed by the National Ethics Committee for Health Research (No.072 NIOPH/NECHR) and the need for informed consent was waived. This study was a part of the Southeast Asia-Acute Kidney Injury (SEA-AKI) study previously published by Srisawat et al.