GLOBAL BURDEN OF ACUTE KIDNEY INJURY: EPIDEMIOLOGY, MORTALITY, AND DISABILITY-ADJUSTED LIFE YEARS

 

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GLOBAL BURDEN OF ACUTE KIDNEY INJURY: EPIDEMIOLOGY, MORTALITY, AND DISABILITY-ADJUSTED LIFE YEARS

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Nguyen Trong Phu
Tran
Nguyen Trong Phu Tran tntphu@ctump.edu.vn Can Tho University of Medicine and Pharmacy Medicine Can Tho Vietnam *
Jeerath Phannajith jeerathp@gmail.com Chulalongkorn University Medicine Bangkok Thailand -
Pichayapa Harnpramukkul pichayapa.nam@gmail.com Chulalongkorn University Medicine Bangkok Thailand -
Suri Tangchitthavorngul suntangmd@gmail.com Naresuan University Medicine Phitsanulok Thailand -
Pongpon Suttiruk oou_70@hotmail.com King Chulalongkorn Memorial Hospital Excellence Center for Critical Care Nephrology Bangkok Thailand -
Piyanut Kaewdoungtien pynkdt@yahoo.com Police General Hospital Nephrology Bangkok Thailand -
Prit Kusirisin prit.kusirisin@cmu.ac.th Chiang Mai University Medicine Chiangmai Thailand -
John Kellum kellum@pitt.edu University of Pittsburgh Center for Critical Care Nephrology Pittsburgh United States -
Nattachai Srisawat drnattachai@yahoo.com Chulalongkorn University Medicine Bangkok Thailand -
 
 
 
 
 
 

Acute kidney injury (AKI) is a major global health problem with high morbidity, mortality, and risk of progression to chronic kidney disease. Although its significance has been increasingly recognized, its full global health impact has not been quantified.

We conducted a global burden estimation of acute kidney injury (AKI) integrating data from a systematic review and meta-analysis of epidemiological studies (2013–2023) with international demographic and health system datasets. The systematic review followed PRISMA 2020 guidelines and included observational studies reporting AKI incidence or mortality, identified through PubMed and Scopus (searched on July 1, 2025). Eligible studies reported population-based or hospital-based data using KDIGO or RIFLE definitions. Pooled estimates were obtained using multilevel random-effects meta-analysis, adjusting for AKI detection methods, study period, and country or WHO region. Hospital-based incidence rates were standardized to person-years using catchment populations estimated from hospital bed density. Population size and life expectancy were retrieved from the World Bank; mortality distributions from the WHO mortality database; and hospital capacity data from the WHO Global Health Observatory. Years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALYs) were calculated using standard burden of disease methods, assuming disability weight 0.5 and disease duration 1.5 months.

Caption: AKI DALY rate by WHO region. disability-adjusted life year (DALY) rate per 100,000 population. Estimates with 95% confidence intervals are derived from pooled analyses of 88 studies (2013–2023).

We screened 16,485 abstracts and included a total of 88 studies, which covered AKI epidemiological data from 35 countries and 6 WHO-defined regions. We estimated 40.8 million (95% CI: 31.02–53.73 million) incident AKI cases annually and 6.7 million (95% CI: 5.02–8.97 million) related deaths worldwide. The global burden was 40.4 million DALYs (95% CI: 30.2–53.9 million), predominantly contributed by YLL. The global DALY rate was 524 per 100,000 population, highest in the Americas 942 (95% CI: 553 – 1,606) per 100,000 population and lowest in South-East Asia at 126 (95% CI: 32 – 505) per 100,000 population. At the national level, Argentina, Japan, Malaysia, and Brazil exhibited the highest DALY rates, while India, Peru, and Pakistan were among the lowest. Uncertainty intervals were wide in regions with sparse data or small populations.

Acute kidney injury represents a substantial global health burden, with DALYs comparable to other major diseases. These findings highlight the urgent need for enhanced early detection, timely management, and structured post-AKI follow-up to mitigate its global impact.

Kewords