Keywords
Acute Kidney Injury
Plasmmodium knowlesi
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.
References
2. William T, Rahman HA, Jelip J, et al. Increasing incidence of Plasmodium knowlesi malaria following control of P. falciparum and P. vivax malaria in Sabah, Malaysia. PLoS Negl Trop Dis. 2013;7:e2026. Doi: 10.1371/journal.pntd.0002026.
3. Barber BE, William T, Grigg MJ, et al. A prospective comparative study of knowlesi, falciparum and vivax malaria in Sabah, Malaysia: High proportion with severe disease from Plasmodium knowlesi and P. vivax but no mortality with early referral and artesunate therapy. Clin Infect Dis. 2013;56:383–97.
4. Mishra SK, Mohanty S, Satpathy SK, et al. Cerebral malaria in adults: A description of 526 cases admitted to Ispat General Hospital in Rourkela, India. Ann Trop Med Parasitol. 2007; 101(3):187–93.
5. Saravu K, Rishikesh K, Parikh CR. Risk Factors and Outcomes Stratified by Severity of Acute Kidney Injury in Malaria. PLoS One. 2014 Mar 13;9(3):e90419. Doi: 10.1371/journal.pone.0090419.
6. Koopmans LC, von Wolfswinkel MEV, Hasselink DA, et al. Acute Kidney Injury in Imported Plasmodium Falciparum Malaria. Malar J. 2015 Dec;14(1):523
7. Saravu K, Rishikesh K, Parikh CR. Risk Factors and Outcomes Stratified by Severity of Acute Kidney Injury in Malaria. PLoS ONE. 2014 Mar; 9(3): e90419. Doi: 10.1371/journal.pone.090419
8. Wailairatana P, Westerlund EK, Aursudkij B, et al. Treatment of malarial acute renal failure by hemodialysis. Am J Trop Med Hyg. 1999;60(2):233-237
9. Rasis WM, Rafidah A, Adlan AMT, et al. A Prospective Study of Acute Kidney Injury in Tropical Acute Febrile Illness in West Pahang, Malaysia. Kidney International Reports. 2017;2(4), S16.
10. Kalaiselvam T, Premila AA, Lim TS, et al. Clinical Outcome of Malaria Cases and Malarial Acute Kidney Injury in Hospital Serdang. A Single Centre Experience from 2007 till 2016. Kidney International Reports. 2017;2(4);S24.
11. Department of Statistics, Malaysia. https://www.dosm.gov.my. Accessed 18 October 2019.
12. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Inter. Suppl. 2012;2:1-138.
13. Bellomo R, Ronco C, Kellum JA, Mehta RL, 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(4): R204-212
14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter. Suppl. 2013;3:1-150.
15. World Health Organization. Guidelines for the Treatment of Malaria, Third edition. Geneva. 2015.
16. Naqvi R. Plasmodium vivax causing acute kidney injury: A foe less addressed. Pak J Med Sci 2015; 31 (6): 1472-1475
17. Saravu K, Rishikesh K, Parikh CR. Risk Factors and Outcomes Stratified by Severity of Acute Kidney Injury in Malaria. PLoS ONE. 2014 Mar 13;9(3):e90419. doi:10.1371/journal.pone.0090419
18. Hooi LS, Ong LM, Ahmad G, et al. A population based study measuring the prevalence of chronic kidney disease among adults in West Malaysia. Kidney Int. 2013;84(5):1034-40
19. Murray PT, Mehta RL, Shaw A, et al. Potential use of Biomarkers in Acute Kidney Injury: Report and Summary of Recommendations from the 10th Acute Dialysis Quality Initiative Consensus Conference. Kidney Int. 2014 March; 85(3):513-521.
20. Haase M, Devarajan P, Haase-Fielitz A, et al. The Outcome of Neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies. J Am Coll Cardiol. 2011 Apr 26;57(17):1752-61