Snake envenomation and acute kidney injury: a systematic review and meta-analysis
Abstract
BACKGROUND: Snakebite envenomation remains a health problem in tropical regions and is a recognized cause of acute kidney injury (AKI). Despite numerous regional studies, the global burden and predictors of snakebite-induced AKI have not been systematically quantified. This review aimed to estimate the pooled incidence of AKI following snake envenomation, identify key clinical and laboratory features, and determine the mortality rate and proportion of patients requiring renal replacement therapy (RRT). METHODS: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2015 and 2025 that reported AKI in snakebite patients. Eligible studies included observational and interventional designs with ≥ 10 participants. Data were extracted on study characteristics, incidence of AKI, need for RRT, mortality rate and associated clinical and laboratory features. Quality was assessed using the Joanna Briggs Institute checklist. Pooled incidence estimates were generated using a DerSimonian–Laird random-effects model, and heterogeneity was evaluated using the I² statistic. RESULTS: Thirty studies comprising 8,612 participants met the inclusion criteria. The pooled incidence of AKI following snake envenomation was 23% (95% CI: 17–33%; I² = 97.2%), and among these, 28% (95% CI: 17–43%; I² = 86.9%) required RRT and the pooled mortality rate was 10% (95% CI 4–21%), with substantial heterogeneity (I² = 83%). A high incidence was observed among…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,612 participants or records.
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