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The following is a summary of “Quantifying the Impact of Alternative Definitions of Sepsis-Associated Acute Kidney Injury on its Incidence and Outcomes: A Systematic Review and Meta-Analysis,” published in the April 2024 issue of Critical Care by Donaldson et al.

Researchers conducted a retrospective study assessing the prevalence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients, investigating how different definitions of SA-AKI affect these estimates.

They conducted RCTs involving adults admitted to the ICU with either sepsis or SA-AKI. Data extraction occurred in duplicate, and the risk of bias was evaluated using adapted standard tools. Utilizing a random-effects model, they pooled the data. Heterogeneity was assessed using a single covariate logistic regression model. The primary outcome measured was the proportion of participants in the ICU with sepsis who developed AKI.

The results showed that, of the 189 studies, 154 reported an incidence of SA-AKI, with a total of 150,978 participants. The pooled proportion of patients developing SA-AKI across all definitions was 40% (95% CI, 37–42%), rising to 52% (95% CI, 48–56%) when specific definitions were applied. Variation in SA-AKI incidence was significant based on AKI definition, with the lowest incidence at 26% (95% CI, 24–28%) when renal replacement therapy defined AKI and the highest at 57% (95% CI, 45–69%) with the AKI Network score (P<0.01). Sixty-seven studies involving 29,455 participants reported at least one SA-AKI outcome. At the final follow-up, 48% (95% CI, 43–53%) of SA-AKI patients had died, while 10% (95% CI, 04–17%) of surviving patients remained on dialysis.

Investigators concluded that SA-AKI in ICU sepsis patients was common, raised the risk of death, and worsened kidney function, with outcomes depending on the AKI definition.

Source: journals.lww.com/ccmjournal/abstract/9900/quantifying_the_impact_of_alternative_definitions.320.aspx