Acute Kidney Injury Is Associated With Impaired Cognition And Chronic Kidney Disease In A Prospective Cohort Of Children With Severe Malaria

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dc.contributor.authorConroy, Andrea L.
dc.contributor.authorOpoka, Robert O.
dc.contributor.authorBangirana, Paul
dc.contributor.authorIdro, Richard
dc.contributor.authorSsenkusu, John M.
dc.contributor.authorDatta, Dibyadyuti
dc.contributor.authorHodges, James S.
dc.contributor.authorMorgan, Catherine
dc.contributor.authorJohn, Chandy C.
dc.date.accessioned2022-02-10T19:05:09Z
dc.date.available2022-02-10T19:05:09Z
dc.date.issued2019
dc.description.abstractAcute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. Ugandan children with cerebral malaria (CM, n = 260) and severe malaria anemia (SMA, n = 219) or community children (CC, n = 173) between 1.5 and 12 years of age were enrolled in a prospective cohort study. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to retrospectively define AKI and chronic kidney disease (CKD). Cognitive testing was conducted using the Mullen Scales of Early Learning in children < 5 and Kaufman Assessment Battery for Children (K-ABC) second edition in children ≥ 5 years of age.The prevalence of AKI was 35.1%, ranging from 25.1% in SMA to 43.5% in CM. In-hospital mortality was 11.9% in AKI compared to 4.2% in children without AKI (p = 0.001), and post-discharge mortality was 4.7% in AKI compared to 1.3% in children without AKI (p = 0.030) corresponding to an all-cause adjusted hazard ratio of 2.30 (95% CI 1.21, 4.35). AKI was a risk factor for short- and long-term neurocognitive impairment. At 1 week post-discharge, the frequency of neurocognitive impairment was 37.3% in AKI compared to 13.5% in children without AKI (adjusted odds ratio (aOR) 2.31 [95% CI 1.32, 4.04]); at 1-year follow-up, it was 13.3% in AKI compared to 3.4% in children without AKI (aOR 2.48 [95% CI 1.01, 6.10]), and at 2-year follow-up, it was 13.0% in AKI compared to 3.4% in children without AKI (aOR 3.03 [95% CI 1.22, 7.58]). AKI was a risk factor for CKD at 1-year follow-up: 7.6% of children with severe malaria-associated AKI had CKD at follow-up compared to 2.8% of children without AKI (p = 0.038) corresponding to an OR of 2.81 (95% CI 1.02, 7.73). The presenting etiology of AKI was consistent with prerenal azotemia, and lactate dehydrogenase as a marker of intravascular hemolysis was an independent risk factor for AKI in CM and SMA (p < 0.0001). In CM, AKI was associated with the presence and severity of retinopathy (p < 0.05) and increased cerebrospinal fluid albumin suggestive of blood-brain barrier disruption.AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.en_US
dc.identifier.citationConroy, A. L., Opoka, R. O., Bangirana, P., Idro, R., Ssenkusu, J. M., Datta, D., ... & John, C. C. (2019). Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria. BMC medicine, 17(1), 1-12.en_US
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/2039
dc.language.isoenen_US
dc.publisherBMC medicineen_US
dc.subjectAcute kidney injury, Malaria, Child, Cognition, Mortality, Chronic kidney diseaseen_US
dc.titleAcute Kidney Injury Is Associated With Impaired Cognition And Chronic Kidney Disease In A Prospective Cohort Of Children With Severe Malariaen_US
dc.typeArticleen_US
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