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

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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 languageUndefined/Unknown
JournalPaediatrics and Child Health, East Africa
Publication statusPublished - 1 Feb 2022

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