Prevalence and Factors Associated with Acute Kidney Injury among Malaria Patients in Dar es Salaam: A Cross-Sectional Study

Abstract

Introduction. Falciparum malaria still remains as a major cause of morbidity and mortality worldwide. Acute kidney injury is a known complication of malaria, and it is reported to occur in up to 40% of adult patients with severe falciparum malaria in endemic regions like sub-Saharan Africa. Objectives. To determine the prevalence and factors associated with acute kidney injury among falciparum malaria patients in a tertiary level private hospital in Dar es Salaam. Methodology. In a cross-sectional study design, 104 adults with falciparum malaria were enrolled consecutively over 6 months from April to September 2015. The diagnosis of acute kidney injury (AKI) in these patients was established using the KDIGO classification criteria. The prevalence of AKI was obtained at 48 hours from admission and at day 7. Different sociodemographic and clinical parameters which were associated with acute kidney injury at 48 hours and at day 7 were identified by hypothesis testing using chi squared tests followed by multivariate logistic regression analysis. Factors with a p value less than 0.05 were considered significant. Results. The participants were predominantly males 65.4% (68/104) and a third (36.5% (38/104)) were between 46 and 65 years. The prevalence of AKI among malaria patients at 48 hours was 26% (27/104). The prevalence of AKI among malaria patients at day 7 was 18.3% (19/104). On multivariate logistic regression, we found that factors that were significantly associated with AKI at 48 hours were male sex (OR 127, CI 3.4–4700, P = 0.008) and hemoglobin <7.5g/dl (OR 36.5, CI 1.7–797.7, P = 0.022), and factor associated with AKI at day 7 was baseline platelet count <25×103 per mm3 (OR 77.8 CI 1.045–5798.6, P = 0.048). Only two patients needed hemodialysis (1.9%) and there were no deaths. Conclusion. Acute kidney injury is a common complication in patient with falciparum malaria. When managed well it has an excellent prognosis and necessitates dialysis in only a minority of patients. Male sex and hemoglobin is associated with AKI at 48 hours and baseline platelet count is associated with AKI at 7 days.

Immunopathology of Acute Kidney Injury in Severe Malaria

“…Prior to the use of the KDIGO consensus guidelines, the prevalence of AKI in malaria had been significantly underrepresented in both adults and children (7,8). Recent studies using the KDIGO classification, have reported that the prevalence of AKI ranges from 20% to 40% among adults and children with SM, while some studies have reported an AKI incidence of as high as 59% for children (9)(10)(11)(12)(13)(14). Despite the similar frequency of AKI between child and adult SM patients, the overall burden of malaria-associated AKI cases is likely to be greater in children, since the vast majority of SM patients in endemic countries are children (15).…”

Severe Malaria with Acute Kidney Injury and Post-Dialysis Hypocalcaemia and Hypertension: A Case Report of a Young Patient Managed in a Resource Limited Setting

“…The Kidney Disease: Improving Global Outcomes (KDIGO) defines AKI as the rapid deterioration of renal function, characterised by either: 1) a reduction in urine output to < 0.5 mL/kg/h for 6 hours, 2) an increase in serum creatinine by at least 0.3 mg/dL (26.53 µmol/L) within 48 hours, or 3) an increase in serum creatinine to at least 1.5 times the baseline within 7 days. Using the KDIGO criteria, recent studies have estimated a high prevalence of AKI in patients with malaria of 20% to 40% in adults and up to 59% in children [8,9]. In this case report, the patient met the first two definitions of AKI.…”

Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

“…Although not available in all low-resource settings, serum creatinine laboratory values are the most commonly used tools to identify AKI. 1,35,[38][39][40][41][42][43][44][45][46][47][48][49][50] A 2015 multinational cross-sectional study showed that the diagnosis of AKI was made with serum creatinine values alone in 63% of participating facilities, followed by serum creatinine along with urine output in 28% of participating facilities in LMICs. 1 A 2018 qualitative study surveying AKI identification and management practices among 160 intensivists based in provincial and regional hospitals in Thailand showed that the KDIGO criteria for AKI were most commonly used (37%), followed by the AKIN (27.7%) and RIFLE (26.1%) criteria, respectively.…”