Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study

Ruth Namazzi; Anthony Batte; Paul Bangirana; Robert Opoka; Andrew Schwaderer; Zachary Berrens; Dibyadyuti Datta; Michael Goings; John Ssenkusu; Stuart Goldstein

Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study

Ruth Namazzi, Anthony Batte, Paul Bangirana, Robert Opoka, Andrew Schwaderer, Zachary Berrens, Dibyadyuti Datta, Michael Goings, John Ssenkusu, Stuart Goldstein

Medical College, East Africa

Research output: Contribution to journal › Article

Abstract

Background: Globally, 85% of acute kidney injury (AKI) cases occur in low-and-middle-income countries. There is limited information on persistent kidney disease (acute kidney disease [AKD]) following severe malaria-associated AKI

Methods: Between March 28, 2014, and April 18, 2017, 598 children with severe malaria and 118 community children were enrolled in a two-site prospective cohort study in Uganda and followed up for 12 months. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI (primary exposure) and AKD at 1-month follow-up (primary outcome). Plasma neutrophil gelatinase-associated lipocalin (NGAL) was assessed as a structural biomarker of AKI

Findings: The prevalence of AKI was 45¢3% with 21¢5% of children having unresolved AKI at 24 h. AKI was more common in Eastern Uganda. In-hospital mortality increased across AKI stages from 1¢8% in children without AKI to 26¢5% with Stage 3 AKI (p < 0¢0001). Children with a high-risk plasma NGAL test were more likely to have unresolved AKI (OR, 7¢00 95% CI 4¢16 to 11¢76) and die in hospital (OR, 6¢02 95% CI 2¢83 to 12¢81). AKD prevalence was 15¢6% at 1-month follow-up with most AKD occurring in Eastern Uganda. Risk factors for AKD included severe/unresolved AKI, blackwater fever, and a high-risk NGAL test (adjusted p < 0¢05). Paracetamol use during hospitalization was associated with reduced AKD (p < 0¢0001). Survivors with AKD post-AKI had higher post-discharge mortality (17¢5%) compared with children without AKD (3¢7%).

Interpretation: Children with severe malaria-associated AKI are at risk of AKD and post-discharge mortality.

Original language	Undefined/Unknown
Journal	Paediatrics and Child Health, East Africa
Publication status	Published - 1 Feb 2022

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Access to Document

http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/286

Cite this

Namazzi, R., Batte, A., Bangirana, P., Opoka, R., Schwaderer, A., Berrens, Z., Datta, D., Goings, M., Ssenkusu, J., & Goldstein, S. (2022). Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study. Paediatrics and Child Health, East Africa. http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/286

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title = "Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study",

abstract = "Background: Globally, 85% of acute kidney injury (AKI) cases occur in low-and-middle-income countries. There is limited information on persistent kidney disease (acute kidney disease [AKD]) following severe malaria-associated AKI Methods: Between March 28, 2014, and April 18, 2017, 598 children with severe malaria and 118 community children were enrolled in a two-site prospective cohort study in Uganda and followed up for 12 months. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI (primary exposure) and AKD at 1-month follow-up (primary outcome). Plasma neutrophil gelatinase-associated lipocalin (NGAL) was assessed as a structural biomarker of AKI Findings: The prevalence of AKI was 45¢3% with 21¢5% of children having unresolved AKI at 24 h. AKI was more common in Eastern Uganda. In-hospital mortality increased across AKI stages from 1¢8% in children without AKI to 26¢5% with Stage 3 AKI (p < 0¢0001). Children with a high-risk plasma NGAL test were more likely to have unresolved AKI (OR, 7¢00 95% CI 4¢16 to 11¢76) and die in hospital (OR, 6¢02 95% CI 2¢83 to 12¢81). AKD prevalence was 15¢6% at 1-month follow-up with most AKD occurring in Eastern Uganda. Risk factors for AKD included severe/unresolved AKI, blackwater fever, and a high-risk NGAL test (adjusted p < 0¢05). Paracetamol use during hospitalization was associated with reduced AKD (p < 0¢0001). Survivors with AKD post-AKI had higher post-discharge mortality (17¢5%) compared with children without AKD (3¢7%). Interpretation: Children with severe malaria-associated AKI are at risk of AKD and post-discharge mortality.",

author = "Ruth Namazzi and Anthony Batte and Paul Bangirana and Robert Opoka and Andrew Schwaderer and Zachary Berrens and Dibyadyuti Datta and Michael Goings and John Ssenkusu and Stuart Goldstein",

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Namazzi, R, Batte, A, Bangirana, P, Opoka, R, Schwaderer, A, Berrens, Z, Datta, D, Goings, M, Ssenkusu, J & Goldstein, S 2022, 'Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study', Paediatrics and Child Health, East Africa. <http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/286>

TY - JOUR

T1 - Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study

AU - Namazzi, Ruth

AU - Batte, Anthony

AU - Bangirana, Paul

AU - Opoka, Robert

AU - Schwaderer, Andrew

AU - Berrens, Zachary

AU - Datta, Dibyadyuti

AU - Goings, Michael

AU - Ssenkusu, John

AU - Goldstein, Stuart

PY - 2022/2/1

Y1 - 2022/2/1

N2 - Background: Globally, 85% of acute kidney injury (AKI) cases occur in low-and-middle-income countries. There is limited information on persistent kidney disease (acute kidney disease [AKD]) following severe malaria-associated AKI Methods: Between March 28, 2014, and April 18, 2017, 598 children with severe malaria and 118 community children were enrolled in a two-site prospective cohort study in Uganda and followed up for 12 months. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI (primary exposure) and AKD at 1-month follow-up (primary outcome). Plasma neutrophil gelatinase-associated lipocalin (NGAL) was assessed as a structural biomarker of AKI Findings: The prevalence of AKI was 45¢3% with 21¢5% of children having unresolved AKI at 24 h. AKI was more common in Eastern Uganda. In-hospital mortality increased across AKI stages from 1¢8% in children without AKI to 26¢5% with Stage 3 AKI (p < 0¢0001). Children with a high-risk plasma NGAL test were more likely to have unresolved AKI (OR, 7¢00 95% CI 4¢16 to 11¢76) and die in hospital (OR, 6¢02 95% CI 2¢83 to 12¢81). AKD prevalence was 15¢6% at 1-month follow-up with most AKD occurring in Eastern Uganda. Risk factors for AKD included severe/unresolved AKI, blackwater fever, and a high-risk NGAL test (adjusted p < 0¢05). Paracetamol use during hospitalization was associated with reduced AKD (p < 0¢0001). Survivors with AKD post-AKI had higher post-discharge mortality (17¢5%) compared with children without AKD (3¢7%). Interpretation: Children with severe malaria-associated AKI are at risk of AKD and post-discharge mortality.

AB - Background: Globally, 85% of acute kidney injury (AKI) cases occur in low-and-middle-income countries. There is limited information on persistent kidney disease (acute kidney disease [AKD]) following severe malaria-associated AKI Methods: Between March 28, 2014, and April 18, 2017, 598 children with severe malaria and 118 community children were enrolled in a two-site prospective cohort study in Uganda and followed up for 12 months. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI (primary exposure) and AKD at 1-month follow-up (primary outcome). Plasma neutrophil gelatinase-associated lipocalin (NGAL) was assessed as a structural biomarker of AKI Findings: The prevalence of AKI was 45¢3% with 21¢5% of children having unresolved AKI at 24 h. AKI was more common in Eastern Uganda. In-hospital mortality increased across AKI stages from 1¢8% in children without AKI to 26¢5% with Stage 3 AKI (p < 0¢0001). Children with a high-risk plasma NGAL test were more likely to have unresolved AKI (OR, 7¢00 95% CI 4¢16 to 11¢76) and die in hospital (OR, 6¢02 95% CI 2¢83 to 12¢81). AKD prevalence was 15¢6% at 1-month follow-up with most AKD occurring in Eastern Uganda. Risk factors for AKD included severe/unresolved AKI, blackwater fever, and a high-risk NGAL test (adjusted p < 0¢05). Paracetamol use during hospitalization was associated with reduced AKD (p < 0¢0001). Survivors with AKD post-AKI had higher post-discharge mortality (17¢5%) compared with children without AKD (3¢7%). Interpretation: Children with severe malaria-associated AKI are at risk of AKD and post-discharge mortality.

M3 - Article

JO - Paediatrics and Child Health, East Africa

JF - Paediatrics and Child Health, East Africa

ER -