Valerie Luyckx et al. have published a new paper in the Lancet Global Health: 'Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review'.
Access to diagnosis and dialysis for acute kidney injury may be life-saving, but in low-income settings can be prohibitively expensive. The burden of AKI in sub-Saharan Africa (SSA) is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care.
We searched Pubmed, African Journals Online, WHO Global Health Library and Web of Science for articles published between January 1 1990 and November 30 2014. We scored studies, all were of medium to low quality. We made a pragmatic decision to include all studies to best reflect reality and did a descriptive analysis of extracted data.
We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex.
Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa