Health inequalities and outcomes following acute kidney injury: a systematic review & meta-analyses of observational studies

TY - JOUR

T1 - Health inequalities and outcomes following acute kidney injury

T2 - a systematic review & meta-analyses of observational studies

AU - Grant, Christopher H.

AU - Dahiya, Anita

AU - Palechuk, Taylor

AU - Lambourg, Emilie

AU - Tan, Beatrix

AU - Mehta, Ravindra L.

AU - Pannu, Neesh

AU - Bell, Samira

N1 - Copyright: © The Author(s) 2025.

PY - 2025/8/27

Y1 - 2025/8/27

N2 - Background: Inequalities in health describe the uneven distribution of health outcomes that result from genetic or environmental factors. The extent to which inequalities impact on outcomes from AKI is uncertain. The aim of this systematic review and meta-analysis was to determine the impact of health inequalities on AKI outcomes. Methods: This review has been registered on PROSPERO (CRD42023422307). We included observational studies of adults who experienced at least one episode of AKI that reported outcomes stratified by sex/gender, race/ethnicity, deprivation, income, education, employment, housing, smoking, mental health conditions, geography or insurance status. The primary outcome was all-cause mortality and secondary outcomes were: progression to acute kidney disease; incident CKD; progressive CKD; AKI recovery; cardiovascular events; hospitalisations; ICU admission and hospital length of stay. The search was conducted in MEDLINE, Embase and Web of Science from inception to 10th January 2024. Study selection, extraction and risk of bias (Newcastle-Ottawa) were performed independently and studies meta-analysed where possible. Results: 7,312 titles/abstracts were screened, and 36 studies included (n=2,038,441). Few included data from lower-middle income countries (n=3). Evidence predominantly related to sex/gender (n=25), race/ethnicity (n=14) and deprivation (n=11). On pooling relevant studies, no sex/gender-specific differences in all-cause mortality or AKI recovery were seen. Of twelve studies reporting mortality by race/ethnicity, six found no variation by racial/ethnic group. Six of nine studies reporting mortality by socioeconomic status found deprivation was an independent predictor of death. Few studies assessed the impact of mental health (n=3), insurance (n=1), housing (n=2), geography (n=1) and smoking status (n=3) and no reports quantified the impact of income, education, employment or substance use. Conclusions: This systematic review highlights a lack of evidence related to inequalities and AKI. Further studies are required to address these gaps and achieve progress towards equitable kidney health.

AB - Background: Inequalities in health describe the uneven distribution of health outcomes that result from genetic or environmental factors. The extent to which inequalities impact on outcomes from AKI is uncertain. The aim of this systematic review and meta-analysis was to determine the impact of health inequalities on AKI outcomes. Methods: This review has been registered on PROSPERO (CRD42023422307). We included observational studies of adults who experienced at least one episode of AKI that reported outcomes stratified by sex/gender, race/ethnicity, deprivation, income, education, employment, housing, smoking, mental health conditions, geography or insurance status. The primary outcome was all-cause mortality and secondary outcomes were: progression to acute kidney disease; incident CKD; progressive CKD; AKI recovery; cardiovascular events; hospitalisations; ICU admission and hospital length of stay. The search was conducted in MEDLINE, Embase and Web of Science from inception to 10th January 2024. Study selection, extraction and risk of bias (Newcastle-Ottawa) were performed independently and studies meta-analysed where possible. Results: 7,312 titles/abstracts were screened, and 36 studies included (n=2,038,441). Few included data from lower-middle income countries (n=3). Evidence predominantly related to sex/gender (n=25), race/ethnicity (n=14) and deprivation (n=11). On pooling relevant studies, no sex/gender-specific differences in all-cause mortality or AKI recovery were seen. Of twelve studies reporting mortality by race/ethnicity, six found no variation by racial/ethnic group. Six of nine studies reporting mortality by socioeconomic status found deprivation was an independent predictor of death. Few studies assessed the impact of mental health (n=3), insurance (n=1), housing (n=2), geography (n=1) and smoking status (n=3) and no reports quantified the impact of income, education, employment or substance use. Conclusions: This systematic review highlights a lack of evidence related to inequalities and AKI. Further studies are required to address these gaps and achieve progress towards equitable kidney health.

KW - acute kidney injury

KW - inequalities

KW - outcomes

KW - social determinants of health

KW - Social determinants of health

KW - Acute kidney injury

KW - Inequalities

KW - Inequities

KW - Outcomes

U2 - 10.1186/s12882-025-04391-x

DO - 10.1186/s12882-025-04391-x

M3 - Article

C2 - 40866848

SN - 1471-2369

VL - 26

JO - BMC Nephrology

JF - BMC Nephrology

M1 - 494

ER -