# Health Care Access, Socioeconomic Status, and Acute Kidney Injury Outcomes: A Prospective National Study

## TL;DR

This study examines acute kidney injury in Kuwait, finding similar mortality rates between locals and expatriates despite differences in healthcare access and demographics.

## Contribution

The study provides the first national data on AKI outcomes in Kuwait, highlighting disparities in healthcare access and patient demographics.

## Key findings

- AKI affects 3.2% of hospitalized patients in Kuwait, with high dialysis use and mortality rates.
- Non-Kuwaitis had higher rates of community-acquired AKI and dialysis need but similar mortality as Kuwaitis.
- Non-Kuwaitis were younger with better baseline kidney function and fewer chronic conditions.

## Abstract

Acute kidney injury (AKI) incidence and outcome in Kuwait are unknown. Moreover, non-Kuwaitis, who represent 66% of the population, have lower income, and their access to public health services is restricted compared with Kuwaitis who have free full access.

Observational prospective multicenter cohort study.

Adult inpatients with AKI in 7 public hospitals from January 1 to December 31, 2021.

AKI identified using Kidney Disease: Improving Global Outcomes serum creatinine-based criteria.

For hospitalized patients with AKI, the outcomes included 30-day outcomes of mortality, need for dialysis, kidney recovery rates, and differences in outcomes between Kuwaitis and non-Kuwaitis.

A backward stepwise multiple logistic regression analysis was performed to assess possible independent risk factors for the outcomes.

We recruited 3,744 patients (mean age: 63 years; mean baseline estimated glomerular filtration rate [eGFR]: 66.7 mL/min; non-Kuwaitis: 42.3%), representing 3.2% of hospitalizations and 19.5% of intensive care unit (ICU) admissions. Non-Kuwaitis were significantly younger (57.6 vs 66.9 years), with higher baseline eGFR (73.1 vs. 62 mL/min), more frequent community acquired AKI (53.8% vs 46.7%), and AKI in summer (34.7% vs 26.9%). Dialysis was provided to 33.5% of patients, with a higher need for non-Kuwaitis (35.5% vs 32.1%). At 30 days, 34.4% of patients died, representing 24.8% of hospital mortality and 59.8% of ICU mortality. No differences in mortality or kidney recovery were noted between Kuwaitis and non-Kuwaitis. Low eGFR did not affect the mortality rate.

Observational nature and short follow-up period of 30 days only.

AKI was associated with high dialysis need and mortality. Non-Kuwaitis accounted for less cases despite representing 66% of the population because they were younger with higher baseline eGFR and fewer comorbid conditions. Non-Kuwaitis had higher rates of community acquired AKI and AKI in summer and a higher need for dialysis but had similar mortality and complete kidney recovery rates.

Incidences of acute kidney injury (AKI), its management, and its outcomes are unknown in Kuwait. In addition, Kuwait has a large population of ethnically diverse expatriates who have lower income and do not enjoy the same level of access to public hospital services. We recruited hospitalized adults who have a diagnosis of AKI in several public hospitals in Kuwait. We analyzed characteristics, management, and outcomes data for more than 3,700 patients and found that AKI affects 3.2% of hospitalized patients. AKI leads to high dialysis utilization rates and causes high mortality rates. Although more Kuwaitis were affected by AKI, the mortality rates for Kuwaitis and non-Kuwaitis were similar. Non-Kuwaitis were younger with better baseline kidney function and fewer chronic diseases than Kuwaitis.