Abstract
Introduction: Malaria remains a major public health problem worldwide. In Mauritania, data on acute kidney injury (AKI) in patients with severe malaria are scarce. This study determined the prevalence of AKI and identified associated factors among indigenous patients hospitalized with severe Plasmodium falciparum malaria.
Methods: This retrospective study was conducted from August 1, 2016, to August 31, 2024, in the Internal Medicine and Infectious Diseases Department of Kiffa Regional Hospital, Mauritania. All indigenous patients admitted with severe Plasmodium falciparum malaria during the study period were included.
Results: Among 10,923 hospitalised patients, 11% (1,168/10,923) tested positive for malaria, and 18.6% (217/1,168) of these had severe malaria, of whom 35.5% (77/217) developed acute kidney injury (AKI). The study population was predominantly female (54.4%) and from rural areas (61.3%), with a mean age of 37.2 years. In multivariate analysis, anemia (aOR: 2.45, 95%CI: 1.20–4.99), severe dehydration (aOR: 2.10, 95%CI: 1.01–4.36), diarrhea (aOR: 3.85, 95%CI: 1.90–7.79), hypotension (aOR: 4.55, 95%CI: 2.15–9.62), and acute pulmonary edema (aOR: 6.70, 95%CI: 1.28–35.02) were independently associated with AKI, whereas vomiting (aOR: 0.35, 95%CI: 0.15–0.80) indicating lower odds of AKI, although this association should not be interpreted as a causal protective effect. Age, sex, seizures, and fever were not significantly associated with AKI.
Conclusion: Acute kidney injury is a common and serious complication of severe malaria, affecting more than one-third of patients. Anaemia, severe dehydration, diarrhoea, hypotension, and acute pulmonary oedema are key independent risk factors, while vomiting showed an inverse association with AKI, but this should not be interpreted as a causal protective effect. Early identification and management of these high-risk patients are crucial to prevent AKI and improve clinical outcomes, particularly in resource-limited, malaria-endemic settings.