In addition, the current study findings, revealed that patients may present late with AKI stage 3 to hospital or large referral health care centers, which suggest more severe AKI at admission, greater need for dialysis and an increased risk of death. Tragically, patients continue to die in large numbers in developing countries as a result of this disorder due to the significant delay in seeking health care and an inability of patients to get to and pay for it. According to the nationwide multicenter survey on AKI conducted by Yang et al.
, (2015) (124) in China, Of 2,223,230 patients admitted to the 44 hospitals screened in 2013, 154?950 (7%) were suspected of having AKI by electronic screening, of whom 26?086 patients (from 374?286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0.99% (3687 of 374,286) by KDIGO criteria, from which they estimated that 1.4 – 2.9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74.
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2% (5608 of 7555 with available data). Renal referral was done in 21.4% (1625 of 7604) of the AKI cases, and RRT was done in 59.3% (531 of 896) of those who had the indications.
Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortality. In Haiti, Remillard et al., (2010) (125) reported that only 19 patients were referred to the Renal Disaster Relief Task Force in Port-au-Prince during the earthquake despite >300,000 casualties