Ethnic Disparity and Differences in Acute Kidney Injury Management and Outcome: A Prospective Observational Multi-Center Study

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