Title
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.
Publication ( Name of Journal)
Elsevier
Recommended Citation
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. Elsevier, 44.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/286
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Comments
This work was published before the author joined Aga Khan University.