Abstract

Research Article

The outcome of Acute Kidney Injury in patients with severe Malaria

João Alberto Brandão**, João Egidio Romão Jr* and João Alberto Brandão

Published: 08 November, 2017 | Volume 1 - Issue 1 | Pages: 048-054

Background: Acute kidney injury (AKI) is a frequent and serious clinical complication in patients with severe malaria. The purpose of this study was to assess the incidence of AKI in a large population of hospitalized patients with a primary admission diagnosis of malaria, and to investigate the robustness of the KDIGO criteria for predicting the need for dialysis, length of hospital stay and hospital mortality.

Results: We studied 695 consecutive patients admitted with primary diagnoses of malaria, in a 6 months period. AKI occurred in 86 (12.4%) patients (Stage 1 in 30.2%, Stage 2 in 23.3% and Stage 3 in 46.5%), and 19 (22.1%) patients required hemodialysis. No patient in the no-AKI or AKI Stage 1 groups (admission or maximum AKI Stage) required hemodialysis, and the requirement of hemodialysis was higher in patients with AKI Stage 2 (23.1%) and Stage 3 (42.4%). The length of hospital stay was longer (7.3±7.4 days vs 5.1±3.0 days; t=4.996, p<0.0001), and mortality was higher in patients who developed AKI than in those who did not (22,5% vs 2,5%; χ2=79.52; p<0.0001). Patients with AKI Stage 1, 2 and 3 had significantly higher hospital mortality (11%, 23% and 30%, respectively), compared with 2.5% for patients without AKI [odds ratio 5.2 (1.40-19.11, p=0.0331), 13.2 (4.24-41.06, p=0.0002), and 16.9 (7.26-36.65, p<0.0001)], respectively.

Conclusion: In a relatively large cohort of patients with falciparum malaria infection, the KDIGO criteria identified 12.4% with a diagnosis of AKI. The KDIGO classification was robust in this population for predicting the need for dialysis, length of hospital stay and hospital mortality. The results support the utilization of the KDIGO criteria in diagnosis and to predicting outcomes for patients with malarial AKI.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001007 Cite this Article Read Full Article PDF

Keywords:

Acute kidney injury; Hemodialysis; Kidney Disease: Improving global outcomes criteria; Malaria; Outcome

References

  1. Muentener P, Schlagenhauf P, Steffen R. Imported malaria (1985–95): trends and perspectives. Bull World Health Organ. 1999; 77: 560-566. Ref.: https://goo.gl/mvdhAr
  2. Sachs J, Malaney P. The economic and social burden of malaria. Nature. 2002; 415: 680-685. Ref.: https://goo.gl/9oV4kb
  3. Das BS. Renal failure in malaria. J Vector Borne Dis. 2008; 45: 83–97. Ref.: https://goo.gl/vRskvS
  4. Sitprija V. Nephropathy in falciparum malaria. Kidney Int. 1988; 34: 867-877. Ref.: https://goo.gl/4pG4bG
  5. Bulbol WS, Carneiro M, Cardoso AC, Alecrim WD, de Albuquerque BC, et al. Acute kidney failure in Plasmodium falciparum malaria. Rev Inst Med Trop Sao Paulo. 1982; 24: 58-61. Ref.: https://goo.gl/LJSGim
  6. Koopmans LC, van Wolfswinkel ME, Hesselink DA, Hoorn EJ, Koelewijn R, et al. Acute kidney injury in imported Plasmodium falciparum malaria. Malar J. 2015; 24; 14:523. Ref.: https://goo.gl/fC1dPV
  7. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012; 2: 1–138.
  8. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: The second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care. 2004; 8: 204-212. Ref.: https://goo.gl/keemN5
  9. Molitoris BA, Levin A, Warnock DG, Joannidis M, Mehta RL, et al. Improving outcomes from acute kidney injury. J Am Soc Nephrol. 2007; 18: 1992–1994. Ref.: https://goo.gl/vPD4Xk
  10. Pereira M, Rodrigues N, Godinho I, Gameiro J, Neves M, et al. Acute kidney injury in patients with severe sepsis or septic shock: a comparison between the 'Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease' (RIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Clin Kidney J. 2017; 10: 332-340. Ref.: https://goo.gl/W764Df
  11. Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis. 2005; 46: 1038-1048. Ref.: https://goo.gl/4L3U9R
  12. Daily JP. Malaria 2017 Update on the Clinical Literature and Management. Curr Infect Dis Rep. 2017; 19: 28. Ref.: https://goo.gl/L8sucE
  13. Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013; 39: 420-428. Ref.: https://goo.gl/CENYQ5
  14. Roy AK, Mc Gorrian C, Treacy C, Kavanaugh E, Brennan A, et al. A Comparison of Traditional and Novel Definitions (RIFLE, AKIN, and KDIGO) of Acute Kidney Injury for the Prediction of Outcomes in Acute Decompensated Heart Failure. Cardiorenal Med 2013; 3: 26-37. Ref.: https://goo.gl/JPqvyZ
  15. Fujii T, Uchino S, Takinami M, Bellomo R. Validation of the Kidney Disease Improving Global Outcomes criteria for AKI and comparison of three criteria in hospitalized patients. Clin J Am Soc Nephrol. 2014; 9: 848-854. Ref.: https://goo.gl/YyWXKU
  16. Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol. 2014; 9: 12-20. Ref.: https://goo.gl/1L6UZW
  17. Ricci Z, Cruz DN, Ronco C: Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. Nat Rev Nephrol. 2011; 7: 201-208. Ref.: https://goo.gl/gtKQ16
  18. Bhadade R, De'Souza R, Harde MJ, Mehta KS, Bhargava P. A Prospective Study of Acute Kidney Injury According to KDIGO Definition and its Mortality Predictors. J Assoc Physicians India. 2016; 64: 22-28. Ref.: https://goo.gl/uPK9H2
  19. Bouchard J, Mehta RL. Acute Kidney Injury in Western Countries. Kidney Dis (Basel). 2016; 2: 103-110. Ref.: https://goo.gl/ixmCGJ
  20. Li PK, Burdmann EA, Mehta RL. World Kidney Day Steering Committee 2013. Acute kidney injury: global health alert. Kidney Int. 2013; 83: 372-376. Ref.: https://goo.gl/Ff989X
  21. Brandao J, Romao Jr JE. Acute kidney injury in patients with falciparum malaria. An assessment of the RIFLE criteria. Nephrol Dial Transplant. 2012; 27: 21-22.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More