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Epidemiology and long-term outcomes of critically ill patients with severe AKI in India and Southeast Asia

Tangchitthavorngul S, Lumlertgul N, Peerapornratana S, Mai AT, Hasan MS, Loh CTI, et al.

Intensive Care Med, 2025 Jul;51(7):1306-1319.
PMID: 40658243 DOI: 10.1007/s00134-025-08008-7

BACKGROUND: Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality. However, its long-term outcomes, particularly in resource-limited settings, remain poorly understood. This study aimed to evaluate 2-year major adverse kidney events (MAKE) in patients with severe AKI.
METHODS: We analyzed data from the India and Southeast Asia Renal Replacement Therapy (InSEA-RRT) registry, a multicenter cohort study conducted between April 2019 and December 2023 across 24 hospitals in Southeast Asia and India. Critically ill patients with AKI stage 3, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, were enrolled. The primary outcome was 2-year MAKE, defined as a composite of persistent kidney dysfunction, long-term dialysis, and all-cause mortality at 2 years post-enrollment.
RESULTS: A total of 2,315 patients were enrolled, of whom 1,033 (47%) died during hospitalization. Among surviving patients, the incidence of 2-year MAKE was 46.6 per 100 person-years (95% CI 42.7-50.6). Notably, mortality (32%) was the dominant component of MAKE. The incidence of new chronic kidney disease (CKD) and CKD progression at 2 years post-AKI was 58.6 and 35.4 per 100 person-year (95% CI 51.0-67.0 and 26.0-47.0), respectively. Multivariable-adjusted models identified older age, male sex, preexisting CKD, malignancy, cardiac-associated AKI, and non-recovery of kidney function after AKI as independent risk factors for 2-year MAKE.
CONCLUSIONS: Patients with severe AKI face a high incidence of 2-year MAKE and poor long-term clinical outcomes. Early recognition and close follow-up of these patients are crucial. Further research is needed to identify effective strategies to improve long-term outcomes in this high-risk population.

Matched MeSH terms: Renal Replacement Therapy/statistics & numerical data
International comparison of UK registry data (chapter 17)

Caskey F, Steenkamp R, Ansell D

Nephrol Dial Transplant, 2007 Aug;22 Suppl 7:vii185-93.
PMID: 17724048

In 2005, the incidence of renal replacement therapy (RRT) in the United Kingdom was 110 per million of the population (pmp) using the day 0 definition and 103 pmp using the day 90 definition. Relative to the 42 countries reporting data to the USRDS, the day 0 and day 90 rates for RRT incidence in the UK are the 32nd and 35th lowest, respectively. However, the overall incidence for the UK masks higher rates in Scotland, Wales and Northern Ireland (123, 129 and 140 pmp, respectively). Of the six countries with RRT incidence rates comparable with those in the UK (Australia, Finland, Malaysia, New Zealand, Norway and the Netherlands) three had relatively high rates for the age band 20-44, and two had relatively high rates for the age band 45-60. The proportion of incident patients with diabetes as the cause of established renal failure also varied considerably among these six comparator countries from 16% to 40% but rates of peritoneal dialysis utilization were comparable with that in the UK and generally higher than in countries with higher rates of RRT incidence. When transplantation rates were considered alongside prevalence rates for RRT, the UK position appeared relatively high at 46% (11th out of 37 countries), although still considerably lower than in Norway and the Netherlands (72 and 54%, respectively). Although variation in RRT incidence rate exists within the four countries of the UK, the overall RRT incidence, reported for the first time this year, appears similar to that observed in a number of demographically similar countries around the world. Examining the UK alongside the six comparator countries, different patterns of RRT incidence were observed across the age bands and variation in the RRT incidence secondary to diabetes mellitus raised interesting questions. The higher rates of renal transplantation achieved in several of the comparator countries also justifies further analysis.

Matched MeSH terms: Renal Replacement Therapy/statistics & numerical data*
Fulltext Newly diagnosed end stage kidney disease in a single centre in Sabah

Wong KW, Lojikip S, Chan FS, Goh KW, Pang HC

Med J Malaysia, 2017 06;72(3):179-185.
PMID: 28733566 MyJurnal

AIM: To study the epidemiology, clinical characteristics, vascular access, and the short term survival of ESRD patients initiated on dialysis from Hospital Queen Elizabeth (HQE).

BACKGROUND: The number of patients with ESRD is increasing in Sabah, Malaysia. Most patients present late and some live in remote areas with difficult access to healthcare services. Many therefore present with potentially fatal complications.

METHODS: All the newly confirmed ESRD patients who were initiated on renal replacement therapy (RRT) from 1 January to 31 December 2014 were included. The basic epidemiological and clinical data were collected. They were divided into three groups: Group 1 - those known to the medical service and had been prepared properly for the initiation of RRT; Group 2 - those known to the medical service, but were not prepared for the RRT; Group 3 - those with undiagnosed CKD. Outcome is mainly survival at 3rd, 6th, 9th and 12th month.

RESULTS: There were 249 ESRD patients. 153 (61.4%) were male. The average age was 53.3 (range 12 - 83). The main cause of ESRD was diabetic nephropathy (128 patients, 51.4%). Most patients were started on RRT with a catheter (74.3%), 47 patients (18.9%) with a fistula, and 17 patients (6.8%) with a Tenckhoff catheter. 185 (74.3%) patients were not prepared properly (Group 2 - 66.3%, and Group 3 - 8.0%). The survival for 249 patients were 86.3% at 6 months, 77.9% at 12 months. Group 2 has the worst survival (81.9% at 6 months, 71.1% at 12 months).

CONCLUSIONS: Our data showed that most patients (74.3%) were started on dialysis in an unplanned manner with poor survival. A comprehensive and well-supported predialysis programme is needed.

Matched MeSH terms: Renal Replacement Therapy/statistics & numerical data
International comparison of trends in patients commencing renal replacement therapy by primary renal disease

Stel VS, Awadhpersad R, Pippias M, Ferrer-Alamar M, Finne P, Fraser SD, et al.

Nephrology (Carlton), 2019 Oct;24(10):1064-1076.
PMID: 30456883 DOI: 10.1111/nep.13531

AIM: To examine international time trends in the incidence of renal replacement therapy (RRT) for end-stage renal disease (ESRD) by primary renal disease (PRD).
METHODS: Renal registries reporting on patients starting RRT per million population for ESRD by PRD from 2005 to 2014, were identified by internet search and literature review. The average annual percentage change (AAPC) with a 95% confidence interval (CI) of the time trends was computed using Joinpoint regression.
RESULTS: There was a significant decrease in the incidence of RRT for ESRD due to diabetes mellitus (DM) in Europe (AAPC = -0.9; 95%CI -1.3; -0.5) and to hypertension/renal vascular disease (HT/RVD) in Australia (AAPC = -1.8; 95%CI -3.3; -0.3), Canada (AAPC = -2.9; 95%CI -4.4; -1.5) and Europe (AAPC = -1.1; 95%CI -2.1; -0.0). A decrease or stabilization was observed for glomerulonephritis in all regions and for autosomal dominant polycystic kidney disease (ADPKD) in all regions except for Malaysia and the Republic of Korea. An increase of 5.2-16.3% was observed for DM, HT/RVD and ADPKD in Malaysia and the Republic of Korea.
CONCLUSION: Large international differences exist in the trends in incidence of RRT by primary renal disease. Mapping of these international trends is the first step in defining the causes and successful preventative measures of CKD.

Matched MeSH terms: Renal Replacement Therapy/statistics & numerical data*
Funding renal replacement therapy in southeast Asia: building public-private partnerships in Singapore, Malaysia, Thailand, and Indonesia

Morad Z, Choong HL, Tungsanga K, Suhardjono

Am J Kidney Dis, 2015 May;65(5):799-805.
PMID: 25736214 DOI: 10.1053/j.ajkd.2014.09.031

The provision of renal replacement therapy (RRT) in developing economies is limited by lack of financial and other resources. There are no national reimbursement policies for RRT in many countries in Asia. The Southeast Asia countries of Singapore, Malaysia, Thailand, and Indonesia have adopted a strategy of encouraging public-private partnerships to increase the RRT rates in their respective countries. The private organizations include both for-profit and philanthropic bodies. The latter raise funds from ordinary citizens, corporations, and faith-based groups, as well as receive subsidies from the government to support RRT for patients in need. The kidney foundations of these countries play a leadership role in this public-private partnership. Many of the private organizations that support RRT are providers of treatment in addition to offering financial assistance to patients, with hemodialysis being the most frequently supported modality. Public-private partnership in funding RRT is sustainable over the long term with proper organization and facilitated by support from the government.

Matched MeSH terms: Renal Replacement Therapy/statistics & numerical data
Geographic, ethnic, age-related and temporal variation in the incidence of end-stage renal disease in Europe, Canada and the Asia-Pacific region, 1998-2002

ESRD Incidence Study Group, Stewart JH, McCredie MR, Williams SM

Nephrol Dial Transplant, 2006 Aug;21(8):2178-83.
PMID: 16595584

Only unbiased estimates of end-stage renal disease (ESRD) incidence and trends are useful for disease control-identification of risk factors and measuring the effect of intervention.

Matched MeSH terms: Renal Replacement Therapy/statistics & numerical data