Does malaria-related kidney injury leave lasting brain and kidney harm?
In 479 Ugandan children with severe malaria, KDIGO AKI (35%) tracked higher death (aHR 2.30), more cognitive impairment at 2 years (aOR 3.03), and more CKD (7.6% vs 2.8%).
Source
Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria
Study at a glance
- Design
- Cohort — Prospective Ugandan pediatric cohort of cerebral malaria and severe malarial anemia vs community children; AKI/CKD defined retrospectively with KDIGO; cognition followed to 2 years.
- N
- N=652 · CM 260, SMA 219, community children 173; ages 1.5–12 years.
- Population
- Ugandan children 1.5–12 years with cerebral malaria or severe malarial anemia, plus community controls.
- Outcome
- AKI prevalence, in-hospital and post-discharge death, neurocognitive impairment, and CKD at follow-up.
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What they did
Enrolled children with cerebral malaria (n=260) or severe malarial anemia (n=219) and community children (n=173), retrospectively applied KDIGO AKI/CKD definitions, and tested cognition with Mullen (<5 years) or K-ABC (≥5) through 2 years.
What they found
AKI prevalence was 35.1% (25.1% SMA; 43.5% CM). In-hospital death was 11.9% vs 4.2% without AKI; post-discharge death 4.7% vs 1.3% (all-cause aHR 2.30). Cognitive impairment was 37.3% vs 13.5% at 1 week (aOR 2.31) and 13.0% vs 3.4% at 2 years (aOR 3.03). CKD at 1 year: 7.6% vs 2.8% (OR 2.81).
The limits
What it doesn't show
A single admission creatinine and community-estimated baselines likely underestimate AKI and cannot prove AKI itself caused later cognitive loss versus overall severe illness.
Key terms
- AKI
- Acute kidney injury classified with KDIGO using admission creatinine versus estimated baseline.
- CKD
- Chronic kidney disease at follow-up; eGFR <90 mL/min/1.73 m² by Bedside Schwartz.
- Cerebral malaria (CM)
- Severe P. falciparum syndrome; 43.5% had AKI in this cohort.
- Severe malarial anemia (SMA)
- The other severe-malaria arm (n=219); AKI prevalence 25.1%.
- KDIGO
- Kidney Disease: Improving Global Outcomes criteria used for AKI and CKD.
- K-ABC / Mullen
- Cognitive batteries: Mullen if <5 years; Kaufman ABC-II if ≥5.
Flashcards
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Quiz yourself
Severe-malaria arms were about:
Common questions
How common was AKI?
35.1% overall (25.1% in SMA, 43.5% in CM).
Did AKI track death?
Yes—in-hospital 11.9% vs 4.2%; all-cause aHR 2.30.
Cognitive impairment at 2 years?
13.0% with AKI vs 3.4% without (aOR 3.03).
CKD at 1 year?
7.6% after malaria-associated AKI vs 2.8% without AKI.
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