Health inequalities and outcomes following acute kidney injury: a systematic review & meta-analyses of observational studies
Bibliographic record
Abstract
Abstract 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. Conclusion 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. Clinical trial number Not applicable.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.018 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".