“COMPARISON OF CLINICAL PROFILE AND OUTCOMES OF ACUTE KIDNEY INJURY IN DIABETIC AND NON-DIABETIC PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS”

Introduction:

Acute kidney injury affects up to 1% of the general population and 15% of all hospitalized patients, is a widespread health issue around the world. Patients with type 2 diabetes have increased risk for AKI compared with patients without diabetes. We conducted a systematic review and meta-analysis to compare incidence of acute kidney injury in diabetic vs non-diabetic patients and to compare recovery, recurrence of AKI in diabetic and non-diabetic patients and mortality rate between diabetic and non-diabetic patients with acute kidney injury.

Methods:

Systematic review and meta-analysis was reported according to MOOSE guidelines. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022379517).We conducted literature searching across multiple databases PubMed, Embase and Scopus including medical subject heading (MESH) and key terms relating to “Diabetes Mellitus” and “Acute Kidney Injury” on acute kidney injury in diabetic and non-diabetic patients in last 10 years until 20th November 2022. We also manually searched the reference lists of identified articles for additional pertinent studies. Methodological quality of each study was assessed based on the Joanna Briggs Institute (JBI) Critical Appraisal tools. Pooled incidence of AKI and comparison in diabetic and non diabetic patients was done using R software. Forest plot was made from the extracted article to determine level of bias of the study.  Statistical Heterogeneity was investigated with the help of I² statistic. Each point estimate was reported with 95% confidence interval. Methodological heterogenicity was reduced by excluding studies by using leave-one-out meta-analysis. Following data extraction, comparison and outcome assessment were done to determine incidence of AKI, mortality between diabetic and non diabetic patients, to know the severity, recurrence of acute kidney injury, to determine the recovery of acute kidney injury among diabetes and non diabetes patients. Statistical significance of p value < 0.05 was considered as significant.

Results:

Eight studies were included for the meta-analysis. Comparison of incidence of AKI  using random effect model showed that diabetes had 16% more risk of AKI than non diabetes (95% CI, -0.03 to 0.35). There was significant heterogeneity (I2=69%; P<0.01) Leave out meta-analysis forrest plot showed that diabetes had 10% more risk of AKI than non-diabetes (95% CI, 0.03 to 0.18). Heterogeneity (I2) was reduced to 38% with p value of 0.18.  Random effect model (Chi2 = 13.98, P =0.0002, I2 = 93%) applied in meta-analysis showed that there was no difference between recovery of AKI in diabetes and non diabetes (risk difference of 6%, 95% CI -0.53 -0.41, p=0-79).In meta-analysis comparing progression to CKD in patients with AKI showed there was no difference between progression of CKD in diabetes and non diabetes (risk difference of 2%, 95% CI -0.33 to -0.37, p=0.90).The recurrence of AKI was more in diabetes than in non diabetes.

Conclusions:

Incidence, recurrence of AKI in diabetes is more than non diabetes. Progression to CKD in patients of AKI in diabetes and non diabetes showed no difference. there was no difference between recovery of AKI in diabetes and non diabetes. PROSPERO registration: ID: CRD42022379517 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.