ABSTRACT
BACKGROUND: Acute kidney injury (AKI) is common and is associated with significant morbidity and mortality. Socioeconomic status may be negatively associated with AKI as some risk factors for AKI such as chronic kidney disease, diabetes and heart failure are socially distributed. This study explored the socioeconomic gradient of the incidence and mortality of AKI, after adjusting for important mediators such as comorbidities. METHODS: Linked primary care and laboratory data from two large acute hospitals in the south of England, sourced from the Care and Health Information Analytics database, were used to identify AKI cases over a 1-year period (2017-18) from a population of 580 940 adults. AKI was diagnosed from serum creatinine patterns using a Kidney Disease: Improving Global Outcomes-based definition. Multivariable logistic regression and Cox proportional hazard models adjusting for age, sex, comorbidities and prescribed medication (in incidence analyses) and AKI severity (in mortality analyses), were used to assess the association of area deprivation (using Index of Multiple Deprivation for place of residence) with AKI risk and all-cause mortality over a median (interquartile range) of 234 days (119-356). RESULTS: Annual incidence rate of first AKI was 1726/100 000 (1.7%). The risk of AKI was higher in the most deprived compared with the least deprived areas [adjusted odds ratio = 1.79, 95% confidence interval (CI) 1.59-2.01 and 1.33, 95% CI 1.03-1.72 for <65 and >65 year old, respectively] after controlling for age, sex, comorbidities and prescribed medication. Adjusted risk of mortality post first AKI was higher in the most deprived areas (adjusted hazard ratio = 1.20, 95% CI 1.07-1.36). CONCLUSIONS: Social deprivation was associated with higher incidence of AKI and poorer survival even after adjusting for the higher presence of comorbidities. Such social inequity should be considered when devising strategies to prevent AKI and improve care for AKI patients.
ABSTRACT
BACKGROUND: Acute kidney injury (AKI) is a common, serious, but potentially treatable condition. Because AKI is often associated with acidosis, it has become common practice to recommend administration of sodium bicarbonate to correct acid imbalance. OBJECTIVES: To assess the benefits and harms of the use of sodium bicarbonate for people with AKI. The primary outcome measure was all-cause mortality, and secondary outcome measures were patients' need for renal replacement therapy; return to baseline kidney function; and overall survival. SEARCH METHODS: In November 2011 we searched the Cochrane Renal Group's Specialised Register using keywords relevant to this review. The register is populated using searches of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and handsearching records from renal-related journals and conference proceedings. SELECTION CRITERIA: All randomised controlled trials (RCTs) that investigated the use of sodium bicarbonate supplements, administered by any route, for the treatment of adults with AKI were to be included. The search strategy did not restrict inclusion based on an upper age limit or publication language. We did not consider inclusion of studies that investigated use of sodium bicarbonate for AKI prevention. DATA COLLECTION AND ANALYSIS: All authors planned to independently assess and extracted information. Information was to be collected on methods, participants, interventions and outcomes. Results were to be expressed as risk ratios (RR) for dichotomous outcomes or as mean differences (MD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS: Although our literature search identified four studies, none of these met our predetermined selection criteria. Hence, no suitable studies were identified for inclusion in this review. AUTHORS' CONCLUSIONS: We found no RCT evidence - supportive or otherwise - for the use of sodium bicarbonate for people with AKI. We concluded that there is an urgent need for well conducted RCTs in this area.
