Acute Kidney Injury in Children with Severe Malaria Is Common and Associated with Adverse Hospital Outcomes

Abstract

Background The prevalence of acute kidney injury (AKI) in children with severe malaria in sub-Saharan African may have been underestimated. The study aimed to determine the prevalence of AKI in children with severe malaria and its association with adverse hospital outcomes. Methods At presentation, we measured complete blood count, serum bilirubin, and serum electrolytes, urea and creatinine in children with severe malaria. At 24 h after hospitalization, we repeated serum creatinine measurement. Urine passed in the first 24 h of hospitalization was also measured. We defined AKI and its severity using the Kidney Disease: Improving Global Outcome AKI guidelines. Results The study involved 244 children (53.3% males) with a median age of 3.5 (1.9–7.0) years. One hundred and forty-four (59%) children had AKI, and it reached maximum Stages 1, 2 and 3 in 56 (23%), 45 (18.4%) and 43 (17.6%) children, respectively. The majority (86.1%) with AKI had only elevated serum creatinine. Mortality increased with increasing severity of AKI on univariate analysis but weakened on multiple logistic regression. Mortality was also higher in those with both oliguria and elevated serum creatinine than in those with elevated serum creatinine only (50% vs. 4.8%, p < 0.001). Furthermore, children with AKI spent three days more in hospital than those without AKI (p < 0.001). Conclusions Acute kidney injury complicates severe malaria in 6 out of every 10 children and is commonly identified using elevated serum creatinine. It is also associated with adverse hospital outcome.

Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management Challenges

“…16 The incidence of AKI in African children with severe malaria using KDIGO-consensus guidelines versus non-standard AKI definitions, including the WHO criteria, are presented in Figure 1. Using KDIGOcompatible guidelines with appropriate estimates of baseline creatinine, the incidence of AKI in severe malaria ranges between 24-59% [13][14][15][16][17] while using non-standard approaches it ranges from 0-33%. [23][24][25][26][27][28][29][30][31][32] Thus, the WHO criteria for AKI in severe malaria vastly underestimates AKI in pediatric populations and does not align with current global standards.…”

“…Studies using standard criteria identified AKI in 24-59% of children with severe malaria with various approaches to estimate baseline creatinine. [13][14][15][16][17] Studies using alternative AKI definitions showed a wide range of estimates from 0 to 33%. [23][24][25][26][27][28][29][30][31][32] https://doi.org/10.2147/IJNRD.S239157…”

“…There are emerging data using consensus definitions to define AKI in severe malaria, reporting AKI in 24-59% of children hospitalized with severe malaria. [13][14][15][16][17] When defining AKI, numerous methodologic considerations impact prevalence estimates. This review focuses on AKI in pediatric populations with P. falciparum malaria in sub-Saharan Africa.…”

“…A recent study in Ghana using the admission creatinine as baseline noted an AKI frequency of 2% 27 compared to 32-59% using population approaches. [13][14][15][16] A study in Ugandan children with serial creatinine measurements over the first four days of hospitalization estimated 79% of AKI cases were present on admission. 41 Another approach to estimate baseline would be to use the discharge or nadir creatinine measure over hospitalization.…”

Quality improvement goals for pediatric acute kidney injury: pediatric applications of the 22nd Acute Disease Quality Initiative (ADQI) conference

“…Pediatric populations at risk for AKI are outlined in Table 1 [1-4, 6, 7, 10, 16-18, 22, 27, 29-31]. Examples of procedures and disease states which are associated with AKI are outlined in Table 2 [1,2,10,11,18,24,30,[32][33][34][35]. Indeed, most pediatric patients in high-income countries with AKI do not have primary kidney disease [1-6, 16, 22].…”