Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria

Andrea L. Conroy, Robert O. Opoka, Paul Bangirana, Richard Idro, John M. Ssenkusu, Dibyadyuti Datta, James S Hodges, Catherine Morgan, Chandy C. John

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Abstract

Background: Acute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. Methods: 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. Results: 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. Conclusions: AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.

Original languageEnglish (US)
Article number98
JournalBMC medicine
Volume17
Issue number1
DOIs
StatePublished - May 21 2019

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Chronic Renal Insufficiency
Acute Kidney Injury
Cognition
Malaria
Odds Ratio
Pediatrics
Cerebral Malaria
Azotemia
Kidney Diseases

Keywords

  • Acute kidney injury
  • Child
  • Chronic kidney disease
  • Cognition
  • Malaria
  • Mortality

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Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria. / Conroy, Andrea L.; Opoka, Robert O.; Bangirana, Paul; Idro, Richard; Ssenkusu, John M.; Datta, Dibyadyuti; Hodges, James S; Morgan, Catherine; John, Chandy C.

In: BMC medicine, Vol. 17, No. 1, 98, 21.05.2019.

Research output: Contribution to journalArticle

Conroy, Andrea L. ; Opoka, Robert O. ; Bangirana, Paul ; Idro, Richard ; Ssenkusu, John M. ; Datta, Dibyadyuti ; Hodges, James S ; Morgan, Catherine ; John, Chandy C. / Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria. In: BMC medicine. 2019 ; Vol. 17, No. 1.
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abstract = "Background: Acute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. Methods: 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. Results: 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. Conclusions: AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.",
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T1 - Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria

AU - Conroy, Andrea L.

AU - Opoka, Robert O.

AU - Bangirana, Paul

AU - Idro, Richard

AU - Ssenkusu, John M.

AU - Datta, Dibyadyuti

AU - Hodges, James S

AU - Morgan, Catherine

AU - John, Chandy C.

PY - 2019/5/21

Y1 - 2019/5/21

N2 - Background: Acute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. Methods: 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. Results: 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. Conclusions: AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.

AB - Background: Acute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. Methods: 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. Results: 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. Conclusions: AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.

KW - Acute kidney injury

KW - Child

KW - Chronic kidney disease

KW - Cognition

KW - Malaria

KW - Mortality

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