A Retrospective Study on the Incidence and Outcomes of Acute Kidney Injury among Patients Diagnosed with Malaria Infection in Sabah – a Tertiary Centre Experience

Abstract

Introduction

Acute kidney injury (AKI) is one of the most common complications of malaria infection. Plasmodium knowlesi is the most common malaria reported in Malaysia, this is not reported elsewhere.  It has been suggested that severe malaria occurred more frequently in P. knowlesi infection compared to P. falciparum.

Methods

We conducted a retrospective cohort study to measure the incidence and outcomes of AKI among patients admitted to a state tertiary hospital for malaria infection for the year 2018.

Results

There were 173 cases of malaria infection reported in Queen Elizabeth Hospital, Sabah in 2018. Fifty-three cases were excluded as case notes were unavailable. Among the 120 cases included in analysis, 97.5% (117/120) were Plasmodium knowlesi infection. 19.2% (23/120) were classified as severe malaria. 31.7% (38/120) developed AKI as per KDIGO criteria.  Among those with AKI, 50% (19/38) were Stage 1, 29% (11/38) were Stage 2, 21% (8/38) were stage 3. 7.8% (3/38) patients with AKI required temporary haemodialysis. Upon discharge, 81.6% (31/38) of AKI patients had recovered their renal function. At 3 months, 13% (5/38) of AKI patients had persistent renal impairment, with eGFR ranging from 44.2 – 51.9ml/min/1.73m2. Multivariate analysis showed that age 50 years old and older (OR 3.25; CI 1.37, 7.73; p=0.008), and high total bilirubin count (OR 5.6; CI 1.73, 18.12, p=0.004) were associated with the development of acute kidney injury.

Conclusion

AKI is common in malaria infection. Up to 13% of patients with AKI progress to chronic kidney disease at 3 months followup.