World Kidney Day and acute kidney injury

Abstract

To the Editor: In their recent editorial,1.Shah S.V. Feehally J. The third world kidney day: looking back and thinking forward.Kidney Int. 2008; 73: 372-374Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Dr Shah and collaborators described the history and perspectives of the upcoming third World Kidney Day. Conspicuously absent from their article and program is the recognition of acute kidney injury (AKI) as an equally important global problem of immense consequences both in developed and developing countries. As recently described,2.Bagga A. Bakkaloglu A. Devarajan P. et al.Improving outcomes from acute kidney injury: report of an initiative.Pediatr Nephrol. 2007; 22: 1655-1658Crossref PubMed Scopus (46) Google Scholar,3.Molitoris B.A. Levin A. Warnock D.G. et al.Improving outcomes of acute kidney injury: report of an initiative.Nat Clin Pract Nephrol. 2007; 3: 439-442Crossref PubMed Scopus (115) Google Scholar recent epidemiological studies and newer diagnostic criteria have demonstrated that the incidence of AKI is higher than previously estimated, and is increasing around the world.4.Cerda J. Lameire N. Eggers P. et al.Epidemiology of acute kidney injury.Clin J Am Soc Nephrol. 2008; 3 (e-pub ahead of print 1 May 2008)Crossref PubMed Scopus (182) Google Scholar Moreover, it is increasingly evident that chronic kidney disease does not completely explain the increasing incidence of end-stage renal disease. Recent measurements of this problem have suggested that AKI is a significant contributor to the prevalence of chronic kidney disease and end-stage renal disease.5.Collins A.J. Foley R. Herzog C. et al.Excerpts from the United States renal data system 2007 annual data report.Am J Kidney Dis. 2008; 51: S1-S320PubMed Google Scholar, 6.Coresh J. Selvin E. Stevens L.A. et al.Prevalence of chronic kidney disease in the United States.JAMA. 2007; 298: 2038-2047Crossref PubMed Scopus (3662) Google Scholar, 7.Hsu C.Y. Linking the population epidemiology of acute renal failure, chronic kidney disease and end-stage renal disease.Curr Opin Nephrol Hypertens. 2007; 16: 221-226Crossref PubMed Scopus (48) Google Scholar The impact of AKI is especially important in the developing world, the place of residence of more than 50% of the world population, where the young and the economically productive populations are predominantly affected. In these regions, hemolytic uremic syndrome4.Cerda J. Lameire N. Eggers P. et al.Epidemiology of acute kidney injury.Clin J Am Soc Nephrol. 2008; 3 (e-pub ahead of print 1 May 2008)Crossref PubMed Scopus (182) Google Scholar, 8.Askenazi D.J. Feig D.I. Graham N.M. et al.3-5 year longitudinal follow-up of pediatric patients after acute renal failure.Kidney Int. 2006; 69: 184-189Abstract Full Text Full Text PDF PubMed Scopus (303) Google Scholar, 9.Cerda J. Bagga A. Kehr V. et al.The contrasting characteristics of acute kidney injury in developed and developing countries.Nat Clin Pract Nephrol. 2008; 4: 138-153Crossref PubMed Scopus (133) Google Scholar, 10.Rivero M.A. Padola N.L. Etcheverria A.I. et al.[Enterohemorrhagic Escherichia coli and hemolytic–uremic syndrome in Argentina].Medicina (B Aires). 2004; 64: 352-356PubMed Google Scholar and obstetric complications11.Prakash J. Kumar H. Sinha D.K. et al.Acute renal failure in pregnancy in a developing country: twenty years of experience.Ren Fail. 2006; 28: 309-313Crossref PubMed Scopus (40) Google Scholar are among the main mechanisms leading to chronic kidney disease and end-stage renal disease. In the developing world, prevention is often the only alternative, as treatment costs are commonly beyond the financial abilities of individuals and governments.9.Cerda J. Bagga A. Kehr V. et al.The contrasting characteristics of acute kidney injury in developed and developing countries.Nat Clin Pract Nephrol. 2008; 4: 138-153Crossref PubMed Scopus (133) Google Scholar Moreover, in these areas prevention is possible and in some cases quite achievable, as shown by reductions in gastroenteritis-induced dehydration and septic abortion-related AKI.9.Cerda J. Bagga A. Kehr V. et al.The contrasting characteristics of acute kidney injury in developed and developing countries.Nat Clin Pract Nephrol. 2008; 4: 138-153Crossref PubMed Scopus (133) Google Scholar Regional and world current initiatives12.Zuccotti G. DeAngelis C.D. Malaria 2007—progressing research, persisting challenges.JAMA. 2007; 297: 2285-2286Crossref PubMed Scopus (4) Google Scholar are likely to reduce the incidence and complications of AKI and therefore decrease the burden of chronic kidney disease and end-stage renal disease. Worldwide efforts geared toward the accurate ascertainment of the real incidence of AKI and its impact are necessary: uncertainty about the true incidence of AKI limits its visibility and its political impact and thus hampers efforts to limit its occurrence and to hasten prevention. AKI must be an integral part of the worldwide initiatives of the national and international societies involved in Word Kidney Day. Ongoing initiatives must be supported and new initiatives propitiated to achieve significant reduction in morbidity and mortality due to renal disease around the world.