Malaria is the Leading Cause of Acute Kidney Injury Among Children Undergoing Dialysis in Lusaka, Zambia: a Retrospective Study

Abstract

Background: Recent studies have shown a shift in the traditional aetiologies commonly associated with tropical acute kidney injury (AKI) in some parts of Africa. In many low-income regions limited access to dialysis increases the risk of AKI-associated adverse outcomes. The goal of this study was to evaluate the aetiology, predictors of the need for dialysis, and outcomes of AKI among children evaluated by the renal service in Lusaka, Zambia. Methods: This retrospective study included children less than 16 years old, who were diagnosed with AKI between 2016 and 2021 and followed up by the renal service at the University Teaching Hospitals- Children’s hospital (UTH-CH). AKI was defined and staged using the KDIGO 2012 criteria. Data were extracted from patient folders using a pre-designed tool and then analysed using SPSS version 25. Categorical data were expressed as simple proportions while continuous variables were expressed as either means or median after determination of normality. Correlations were determined using the chi-square test, otherwise Fischer’s exact test in the case of categorical variables, and the independent t-test for continuous variables. The significance level was set at a p-value < 0.05. The predictors of need for dialysis, poor patient outcome, and malaria-associated AKI (MAKI) were identified by using binary logistic regression. Results: The 126 (37.7%) children diagnosed with AKI had a median age of 7.5 (interquartile range 0.3-16) yearsand a male-to-female ratio of 1.4. Of these, a total of 94(74.6%) underwent dialysis with 65(82.1%) receiving peritoneal dialysis (PD), 8(8.5%) receiving haemodialysis (HD), and 4(4.3%) undergoing both modalities. Predictors of need for dialysis were oliguria (OR 10.4, p= 0.002) and anuria (OR 8.7, p, 0.006) while the leading aetiologies of AKI were malaria (77, 60%) and glomerular disease (21, 16.6%). Twenty-three (18.3 %) children developed chronic kidney disease (CKD), 7(5.6 %) died and a year later 97 (77%) were lost to follow-up. Conclusion: Malaria is the leading cause of AKI and children from areas of medium malaria transmission intensity are at increased risk. Three-quarters of children in the cohort required dialysis. CKD and mortality rates may be underestimated due to the high loss to follow- up rate.

Clinical, immune and genetic risk factors of malaria-associated acute kidney injury in Zambian Children: A study protocol

“…[4,5,6,7,8] At Lusaka's University Teaching Hospitals-Children ' s Hospital (UTH-CH), malaria stands as the predominant cause (60%) of AKI in children undergoing dialysis, with nearly 20% of these cases progressing to CKD. [9] The development of CKD and endstage kidney disease (ESKD) in these patients, is life-limiting due to constraints in access to kidney replacement therapy and transplantation. [10] Yet despite this state of affairs, the epidemiology, immune and genetic risk factors of MAKI are incompletely described in our population.…”