ABSTRACT
Introduction: Kuwait has a large expatriate community, representing almost two thirds of the total population of 4,464,100. They are non-citizens with a temporary residency permit and have a limited access to public health care provided by ministry of health compared to Kuwaiti citizens. We examined differences in basic characteristics, management, and outcomes between Kuwaitis and non-Kuwaitis who developed acute kidney injury (AKI) Methods: Demographics, comorbidities, dialytic and non-dialytic management data, and kidney and patient outcomes at 30 days from nephrology consultation for all nephrology consultations for AKI in seven public hospitals in Kuwait, from January 1 to June 30, 2021, were prospectively collected and analyzed Results: The total number of AKI referrals was 3749 (hospital-acquired AKI: 50%;males: 59%;mean age: 63 years;patients with eGFR < 60: 42%). Patients with baseline eGFR < 60 were older than patients with eGFR of >= 60 (mean age: 68 vs. 59 years), had lower mean initial Hgb (10.1g/dL vs. 10.8g/dL) and had higher rates of DM (83% vs. 60%), HTN (86% vs. 62%), and cardiac disease (60% vs 38%). More than 50% of AKI cases were due to ATN. Non-Kuwaitis had a small but statistically significant higher rates of COVID-19 related AKI (9% vs 7% of AKI in Kuwaitis were related to COVID-19). During the course of AKI, 80% received fluids, 45% received diuretics and 42% received vasopressors. Expatriates represent two thirds of the total population of Kuwait;however, they accounted for only 43% of all AKI cases. They were younger than Kuwaitis (58 vs 67), had more male involvement (72% were men vs 50% men in the Kuwaiti group), had higher mean baseline eGFR (73 mL/min vs 62 mL/min for Kuwaitis), and higher mean baseline Hgb (10.8g/dL vs 10.3g/dL). More hospital acquired AKI than community acquired AKI in expatriates (54% vs 46%), whereas the opposite seen in Kuwaiti patients (53% community acquired vs 47% hospital acquired), and more AKI in the summer than the winter (62% in summer vs 38% in winter). However there was no seasonal difference for Kuwaiti patients. No difference in the need for invasive ventilation Dialysis was needed for 33.5% of the total cohort, significantly higher utilization for expatriates (35% vs 32% of Kuwaitis requiring dialysis). Continuous dialysis was the initial modality in 90% of cases. However, no difference at 30 days in percentage of patients still on dialysis At 30 days, 41% of the total cohort died with significantly higher death rates in Kuwaitis (39% of expatriates vs 43% of Kuwaitis died). Kuwaiti patients who died were older (69 years vs 58 years for expatriates). Of patients who needed dialysis, 55% died while on dialysis Mean final eGFR at 30 days for those who survived and were off dialysis was 49 mL/min, and was significantly higher for expatriates (54 mL/min vs 46 mL/min for Kuwaitis) Conclusion(s): Despite being two thirds of the population, expatriates accounted for only 43% of AKI case, since they were younger with higher baseline eGFR. However, they had higher rates of AKI in Summer (probably due to increased risk of lack of air conditioning where they work or live), higher rates of COVID-19 related AKI (probably due to delayed vaccination of expatriates compared to Kuwaitis) and higher need for dialysis. However, at 30 days, they had lower rates of mortality, similar rates of recovery from dialysis and higher mean final eGFR No conflict of interestCopyright © 2023
ABSTRACT
Background: Little is known about AKI epidemiology, causes, management and outcome in Kuwait. We report that. Methods: Demographics, comorbidities, treatment and 4 weeks outcome data for nephrology referrals for AKI in 7 public hospitals from 1/Jan-30/Apr/2021 prospectively collected and analyzed Results: Total number of AKI referrals was 1298, that is 3.3% of hospital admissions. Community acquired cases were 12.5%. Males were 57%, mean age 64 (52% > 65), and Kuwaiti citizens 65%. DM affected 71%, HTN 74%, and cardiac disease 36% of patients. Mean baseline eGFR before AKI was 62. Baseline eGFR < 60 seen in 52%, and those compared to patients with eGFR > 60, had mean baseline eGFR of 35 (vs 90), were older (68 vs 60 with 61% above age 65 vs 41%), 81% had DM (vs 60%), 85% had HTN (vs 63%), 46% had cardiac disease (vs 24%). Cause of AKI was pre-renal / ischemic ATN in 87%, COVID-19 related in 8%, contrast-associated in 6%, drug-induced AIN in 5% of cases. Many had more than one possible cause. Sepsis was most common precipitating factor seen in 67% then volume depletion in 50%. Many had more than one factor. IV fluids used in 73% (less in lower eGFR group), IV diuretics in 46% (more in lower eGFR group), IV vasopressors in 40% (less in lower eGFR group) and steroids in 33%. KRT needed in 33%, more in patients who used diuretics or vasopressors. Volume overload and electrolytes / acid-base disorders were most common indication (75% and 79% respectively). CKRT was modality of choice in 85%, however, in 52% of CKRT, conventional HD not used due to lack of dialysate source in some sites. At 30 days, mean eGFR was 42%, with complete recovery in 34%, and 38% failed to recover at all. Death occurred in 31%, 55% had baseline eGFR > 60, and 50% of deaths occurred while still on KRT. Non-survivors were older and had higher use of vasopressors. AKI associated mortality in 25% of total hospital mortality and in 31% of ICU / CCU mortality. Conclusions: AKI is common. Most cases hospital-acquired. Use of resources (medications, critical care, KRT) and rates of mortality are high. Kuwaiti citizens represent 1/3 of the population and 2/3 of AKI cases and almost 70% of deaths.