Abstract:
Background: Acute kidney injury is a frequent complication of malaria. There is no data about this problem in Rwanda. The purpose of this study was to determine the incidence and risk factors of acute kidney injury in malaria patients presenting to 2 rural district hospitals located in malaria endemic areas in Rwanda.
Methods: After excluding patients with concurrent infectious diseases, pregnant women, children under 15 years of age, people who refused to sign consent, and those with one or no serum creatinine measurement, we included 100 patients in the analysis. AKI was defined as an increase in serum creatinine by ≥ 0.3 mg/dl from the baseline within 48 hours. Malaria was diagnosed by either thin, thick smear or rapid test.
We studied those 100 consecutive patients presenting with a primary diagnoses of malaria to NYANZA and NYAGATARE district hospitals, in a 10 months period within the period from April 2018 to January 2019.
Results: AKI occurred in 40(40%) patients. significant risk factors for AKI were: late consultation [RR: 2.1(1.3-3.4, p=0.002)], hypotension at presentation [RR: 1.7(1.1-
2.7,p=0.02)],inability to drink[RR:2.8(1.6-4.9,p<0.001)],patients with diarrhea[RR:2.1(1.33.5,p=0.004)],altered mental status at presentation[RR:2.0(1.3-3.1,p=0.002)],and the presence of underlying chronic diseases[RR:1.7(1.0-2.8,p=0.04)].
The incidence density calculated for our patients during 10 months of our study period was 48.2 person years (40/0.83 year).
Conclusion: In malaria endemic area in Rwanda, a cohort study conducted in 10 months period including all malaria peak seasons in Rwanda, the incidence of AKI was 40%, the incidence density was 48.2 person years. Identified important risk factors were: inability to drink, late referral, concurrent chronic diseases, altered mental status at presentation, hypotension or diarrhea at presentation.
