Acute kidney injury in Plasmodium vivax malaria hospitalized patients in Manaus, Brazilian Amazon: are we underestimating the real burden?

Abstract

Background Acute kidney injury (AKI) is a common complication of Plasmodium falciparum malaria and can also occur secondary to P. malariae infections. Its association with P. vivax malaria is not well estimated neither understood.Methods Retrospective assessment of medical records was conducted among P. vivax malaria hospitalized patients in a reference hospital of Manaus, Brazilian Amazon, from 2009 to 2017. AKI was classified according to Acute Kidney Injury Network (AKIN) criteria and through the World Health Organization (WHO) criteria for severe malaria. Patients diagnosed with primaquine-induced hemolysis due to confirmed glucose 6-phosphate dehydrogenase deficiency (G6PDd) and chronic renal failure were excluded. Prevalence of AKI and factors associated to this complication were assessed.Results Out of 28,095 P. vivax malaria diagnoses during the study period in the reference center, 638 cases (2.3%) required hospitalization; with 433 (67.8%) of those patients having at least one creatinine measure. Twenty-two patients (5.1%) were diagnosed with AKI as per WHO criteria; 241 patients presented more than two creatinine measures, of which 117 (49.2%) patients had AKI per AKIN criteria. These were stratified in stage I (n=88; 75.2%), stage II (n=6; 5.1%), and stage III (n=23; 19.6%). Major risk factor for AKI was older age. Renal replacement therapy (dialysis) was necessary in 6 cases (1.4%).Conclusions AKI secondary to vivax malaria was not unfrequent amongst hospitalized patients and may be a potentially severe complication. WHO diagnostic criteria for malaria AKI was shown to underestimate the real burden of AKI. Renal impairment should be closely monitored especially in older patients.