Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems

Meredith R. Hickson; Andrea L. Conroy; Paul Bangirana; Robert O. Opoka; Richard Idro; John M. Ssenkusu; Chandy C. John

doi:10.1371/journal.pone.0226405

Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems

Meredith R. Hickson, Andrea L. Conroy, Paul Bangirana, Robert O. Opoka, Richard Idro, John M. Ssenkusu, Chandy C. John

Pediatrics

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

Abstract

Background Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. Methods We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. Results AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. Conclusions AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.

Original language	English (US)
Article number	e0226405
Journal	PloS one
Volume	14
Issue number	12
DOIs	https://doi.org/10.1371/journal.pone.0226405
State	Published - Dec 2019

Bibliographical note

Funding Information:
This work was supported by the National Institute of Neurological Disorders and Stroke (R01NS055349 to CCJ, https://www.ninds.nih.gov/) and the Fogarty International Center (D43 NS078280 to CCJ, https://www.fic.nih.gov/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the children and their parents who participated in this study, the study team for their dedicated effort in treating the children and collecting the data.

Publisher Copyright:
Copyright: © 2019 Hickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1371/journal.pone.0226405

Find It

Find It at U of M Libraries

Cite this

@article{cf54c9ad2cd44df382ee64079d152b49,

title = "Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems",

abstract = "Background Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. Methods We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. Results AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. Conclusions AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.",

author = "Hickson, {Meredith R.} and Conroy, {Andrea L.} and Paul Bangirana and Opoka, {Robert O.} and Richard Idro and Ssenkusu, {John M.} and John, {Chandy C.}",

note = "Funding Information: This work was supported by the National Institute of Neurological Disorders and Stroke (R01NS055349 to CCJ, https://www.ninds.nih.gov/) and the Fogarty International Center (D43 NS078280 to CCJ, https://www.fic.nih.gov/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the children and their parents who participated in this study, the study team for their dedicated effort in treating the children and collecting the data. Publisher Copyright: Copyright: {\textcopyright} 2019 Hickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2019",

month = dec,

doi = "10.1371/journal.pone.0226405",

language = "English (US)",

volume = "14",

journal = "PloS one",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "12",

}

TY - JOUR

T1 - Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems

AU - Hickson, Meredith R.

AU - Conroy, Andrea L.

AU - Bangirana, Paul

AU - Opoka, Robert O.

AU - Idro, Richard

AU - Ssenkusu, John M.

AU - John, Chandy C.

N1 - Funding Information: This work was supported by the National Institute of Neurological Disorders and Stroke (R01NS055349 to CCJ, https://www.ninds.nih.gov/) and the Fogarty International Center (D43 NS078280 to CCJ, https://www.fic.nih.gov/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the children and their parents who participated in this study, the study team for their dedicated effort in treating the children and collecting the data. Publisher Copyright: Copyright: © 2019 Hickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2019/12

Y1 - 2019/12

N2 - Background Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. Methods We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. Results AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. Conclusions AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.

AB - Background Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. Methods We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. Results AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. Conclusions AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.

UR - http://www.scopus.com/inward/record.url?scp=85076687920&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076687920&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0226405

DO - 10.1371/journal.pone.0226405

M3 - Article

C2 - 31846479

AN - SCOPUS:85076687920

SN - 1932-6203

VL - 14

JO - PloS one

JF - PloS one

IS - 12

M1 - e0226405

ER -

Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems

Abstract

Bibliographical note

PubMed: MeSH publication types

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this