EVALUATING A LOW HEMOGLOBIN THRESHOLD FOR DIALYSIS INITIATION IN SEVERE MALARIA-INDUCED KIDNEY INJURY

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Abstract Title *

EVALUATING A LOW HEMOGLOBIN THRESHOLD FOR DIALYSIS INITIATION IN SEVERE MALARIA-INDUCED KIDNEY INJURY

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Co-author 1

vincent Mboya vnivox1200@gmail.com Amana Regional Referral Hospital Internal medicine dar es salaam Tanzania *

Co-author 2

Robert Magoma robmagoma@gmail.com Amana Regional Referral Hospital Internal Medicine Dar es Salaam Tanzania -

Co-author 3

Pauline Elisha paulineelisha123@gmail.com Amana Regional Referral Hospital Internal Medicine Dar es Salaam Tanzania -

Co-author 4

kamani Matheso kamanigodfrey7@gmail.com Dar es Salaam Internal Medicine Dar es Salaam Tanzania -

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Introduction

The optimal hemoglobin (Hb) threshold for initiating renal replacement therapy (RRT) in patients with malaria-associated kidney injury (MAKI) remains uncertain. Severe anemia (Hb <7 g/dL) is common among these patients, and may delay the initiation of life-saving dialysis due to concerns of hemodynamic instability. This study evaluates the feasibility and safety of initiating urgent RRT in MAKI patients with Hb levels between 5–7 g/dL, using concurrent intradialytic blood transfusion.

Methods

From January 2024 to June 2025, patients aged 20–49 years with MAKI and severe anemia (Hb 5–7 g/dL) who required urgent RRT were included. Exclusion criteria were cardiovascular diseases, diabetes mellitus, malignancies, sickle cell disease, and coagulation disorders. Eligible patients underwent urgent hemodialysis with simultaneous intradialytic blood transfusion, followed by serial transfusions as needed to achieve Hb >7 g/dL.

Results

Among 34 cases of MAKI, 18 (52.9%) required RRT. Of these, 18 patients were initiated on urgent dialysis with concurrent intradialytic transfusion. Sixteen (88.9%) completed an average of 8 dialysis sessions successfully, with full renal recovery and uneventful discharge. Two (11.1%) developed intradialytic hypotension, requiring temporary suspension of RRT and pre-transfusion optimization before reinitiation.

Conclusion

Patients with severe malaria-induced kidney injury (MAKI) and severe anemia (Hb 5–7 g/dL) may safely tolerate urgent dialysis initiation when supported with intradialytic blood transfusion.
Clinical decision-making should be individualized, and larger, well-designed randomized controlled trials are warranted to validate these preliminary findings.

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