Outcome of malaria-associated acute kidney injury: a prospective study from a single center

Objective: The aim of this prospective study was to determine the outcome of patients suffering from malaria with acute renal dysfunction. Methods: All adult patients of laboratory-proven malaria with acute kidney injury (AKI) admitted during the period of May 2010 to June 2011 were included. Patient characteristics, physical examination findings, and laboratory parameters were recorded. Patient outcome was assessed in terms of peak serum creatinine level, duration of hospital stay, need for dialysis, and in-hospital mortality rate. Surviving patients were followed up for 3 months to determine progression to chronic kidney disease. Results: This study enrolled 101 patients of malarial AKI. Mean age was 33.70 +/- 15.39 years. Oliguric AKI was observed in 44.6% cases. Mean duration of hospital stay was 8.75 +/- 7.60 days. Renal replacement therapy was required in 36.6% patients. Ten (9.9%) patients succumbed to illness during hospital stay. Majority of deaths occurred shortly after admission. Mortality risk was significantly associated with raised LDH (p = 0.019), lower hemoglobin level (p = 0.015), raised aspartate transaminases (p<0.001), and elevated alanine transaminases (p = 0.016). Cerebral malaria was an important determinant of mortality (p = 0.002). Renal parameters, including severity of renal dysfunction and need for dialysis, were not associated with mortality risk. Among 91 survivors, 79 patients completed a 3-month follow-up and all of them had normalization of renal function. Conclusion: We observed 9.9% in-hospital mortality rate in the study cohort. Cerebral malaria was an important risk factor for mortality in malarial AKI patients. Severity of renal dysfunction did not correlate with the mortality risk in our study.