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

Document Type

Article

Department

Paediatrics and Child Health (East Africa)

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.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Elsevier

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Link to Full Text

Share

COinS