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Malaria is a leading global cause of mortality, predominantly impacting low-resource nations. Plasmodium primarily targets the microcirculation. Acute kidney injury (AKI) is a common complication, yet limited studies have explored renal involvement in this parasitic infection. This study aims to determine the prevalence and risk factors associated with developing AKI at the time of admission.
We conducted a retrospective cohort study in various Colombian cities, including patients diagnosed with malaria between 2010 and 2020. Inclusion criteria encompassed suspected malaria cases with a microbiological diagnosis through thick or peripheral blood smears. Patients with a history of convulsive syndrome, neurological sequelae, advanced-stage renal, hepatic, hematologic, or pulmonary conditions were excluded. Sociodemographic data, laboratory results, treatment modalities, and complications were extracted. Initial descriptive analysis summarized continuous variables as means and standard deviations for normally distributed data or medians and interquartile ranges for non-normally distributed data. Bivariate analysis compared quantitative variables using Student's t-test or Mann-Whitney U test, depending on their distribution, while chi-squared tests were employed for qualitative variables.
Out of 1288 patients, 704 were excluded due to incomplete medical records (n=649), absence of thick smears (n=35), and negative thick smears (n=20). Our analysis included 584 patients, comprising 124 with complicated malaria (21%) and 460 with uncomplicated malaria (79%). The prevalence of AKI was 18.3% (n=107), with all cases occurring in male patients. The mean age was 25.37 years (range 11.4-69 years), and the average time from symptom onset to consultation was 8.6 ± 5.3 days. Plasmodium falciparum was responsible for 42 cases (39.2%), Plasmodium vivax for 41 (38.3%), and mixed malaria for 24 (22.4%). Factors associated with AKI included systolic blood pressure < 65 mmHg (OR 10.88, 95% CI: 6.74-17.55, p < 0.0001), emetic syndrome at admission (OR 7.88, 95% CI: 4.57-13.56, p < 0.0001), hemoglobin < 9 (OR 4.10, 95% CI: 1.93-8.67, p 0.0002). The only protective factor against development AKI was the initiation of chloroquine within the first 24 hours (OR 0.063, 95% CI: 0.03-0.12, p 0.0001).
This study unveils a high prevalence of AKI in Colombian malaria patients, particularly among males. Low systolic blood pressure, emetic syndrome, low hemoglobin levels, are significantly associated with AKI. Early initiation of chloroquine was a protective factor. This is the largest cohort in Latin America describing patients with acute kidney injury and malaria, emphasizing the importance of early recognition and management of these risk factors to improve patient outcomes. Further research is needed to develop preventive strategies and enhance our understanding of AKI in malaria.