Identification of acute kidney injury in African children hospitalized with malaria: a multinational individual participant data meta-analysis
18 affiliations
- 1Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine
- 2Child Health and Development Centre, Makerere University College of Health Sciences
- 3Department of Pediatrics, Upstate Medical University
- 4Menzies School of Health Research, Charles Darwin University
- 5ISGlobal, Hospital Clínic - Universitat de Barcelona
- 6Nuffield Department of Medicine, University of Oxford
- 7Center for Kidney Health, University College London
- 8Division of Nephrology, Department of Pediatrics, Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center
- 9Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia
- 10Department of Pediatrics, Division of Clinical Medicine, University of Global Health Equity
- 11Department of Pediatrics, Division of Pediatric Nephrology, Texas Children’s Hospital, Baylor College of Medicine
- 12Department of Medicine, University Health Network-Toronto General Hospital, University of Toronto
- 13Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine
- 14Global Health Uganda
- 15Department of Paediatrics, Makerere University College of Health Sciences
- 16Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children’s Hospital, The Ohio State University
- 17Department of Paediatrics, University College Hospital
- 18Faculty of Medicine, Mbarara University of Science and Technology
Abstract
Background Historically, acute kidney injury (AKI) has been an underappreciated complication in children with severe malaria. We conducted an individual patient data meta-analysis to model the impact of AKI and its complications on inpatient mortality in African children hospitalized with malaria. Methods Studies were identified using MEDLINE, EMBASE, Scopus, and PubMed with no language restrictions, as well as through outreach at scientific meetings. Investigators were contacted about participation in the study. Eligible studies included African children hospitalized with Plasmodium falciparum malaria, a serum creatinine measurement, and mortality assessed. The primary exposure was AKI, defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine. The primary outcome was all-cause in-hospital mortality, and dialysis requirement was a secondary outcome. Data were standardized and cleaned, and random-effects meta-analyses were conducted to generate pooled estimates. Results We included 18 studies involving 8 countries and 13,528 children aged 3 months to 16 years over a 33-year period with 951 deaths (7%). The frequency of KDIGO-defined AKI was 47% (95% confidence interval: 46% to 48%), with 47% of children having KDIGO-defined Stage 1 AKI, 30% having Stage 2, and 23% having Stage 3 AKI. Overall, KDIGO-defined AKI was associated with a 2.87 increased odds of mortality (95% CI 2.28 to 3.61) with a monotonic increase in mortality across AKI stage. AKI was a robust risk factor for mortality across era, sex, region, and subgroups. The KDIGO AKI definition was operationalized using simplified age-based thresholds to support bedside recognition of AKI with comparable mortality performance. The WHO-defined AKI threshold (creatinine value >3 mg/dL) occurred in 3.4% (238) of children. All 238 cases identified by WHO criteria were classified as having AKI using KDIGO and age-based definitions, but WHO missed 93% (3059/3297) of additional AKI cases. Conclusions AKI was strongly associated with mortality in African children hospitalized with malaria. Creatinine thresholds can be operationalized to facilitate early AKI recognition. These findings have clinical implications for the implementation of kidney-protective care and for enhanced monitoring of children with severe malaria. Other Funded by National Institutes of Health (1R01AI165946), registered number PROSPERO (CRD42024560012).
Related
- Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a reconstructed individual participant data meta-analysis of randomized controlled trials of intravascular ultrasound- and optical coherence tomography-guided strategies
- Omega‐6 Polyunsaturated Fatty Acids and Peripheral Artery Disease: An Individual Participant‐Level Analysis of 9 International Prospective Studies
- Pooling individual off-pump and on-pump coronary artery bypass patient records from three contemporary multicenter, randomized, controlled trials: an individual participant data meta-analysis protocol
- Identifying eating behaviour phenotype cut-off scores for childhood obesity: an individual participant data meta-analysis using the Child Eating Behaviour Questionnaire (CEBQ)
- Country- and individual-level factors associated with healthy working life expectancy: A multinational longitudinal study
BibTeX
@article{bond2026identification,
title = {{Identification of acute kidney injury in African children hospitalized with malaria: a multinational individual participant data meta-analysis}},
author = {Caitlin Bond and Anthony Batte and Folake Afolayan and Nicholas M. Anstey and Quique Bassat and Philip A. Bejon and James A. Berkley and Rhys D. R. Evans and Stuart L. Goldstein and Michael T. Hawkes and Olayinka Ibrahim and Peace Imani and Chandy C. John and Kevin C. Kain and Claire Liepmann and Kevin Marsh and Ruth Namazzi and Margaret Nakuya and Nicole O’Brien and Lere P Oluwadare and Robert O. Opoka and Jonathan Sserunkuuma and Hunter Wynkoop and Andrea L. Conroy and Malaria Associated Kidney Injury and Disease Consortium in Africa (maKID-Africa)},
journal = {BMC Medicine},
year = {2026},
month = jul,
doi = {10.1186/s12916-026-05072-8},
url = {https://doi.org/10.1186/s12916-026-05072-8},
note = {CC BY},
}
RIS
TY - JOUR
TI - Identification of acute kidney injury in African children hospitalized with malaria: a multinational individual participant data meta-analysis
AU - Caitlin Bond
AU - Anthony Batte
AU - Folake Afolayan
AU - Nicholas M. Anstey
AU - Quique Bassat
AU - Philip A. Bejon
AU - James A. Berkley
AU - Rhys D. R. Evans
AU - Stuart L. Goldstein
AU - Michael T. Hawkes
AU - Olayinka Ibrahim
AU - Peace Imani
AU - Chandy C. John
AU - Kevin C. Kain
AU - Claire Liepmann
AU - Kevin Marsh
AU - Ruth Namazzi
AU - Margaret Nakuya
AU - Nicole O’Brien
AU - Lere P Oluwadare
AU - Robert O. Opoka
AU - Jonathan Sserunkuuma
AU - Hunter Wynkoop
AU - Andrea L. Conroy
AU - Malaria Associated Kidney Injury and Disease Consortium in Africa (maKID-Africa)
PY - 2026
DA - 2026/07/01
JO - BMC Medicine
DO - 10.1186/s12916-026-05072-8
UR - https://doi.org/10.1186/s12916-026-05072-8
AB - Background Historically, acute kidney injury (AKI) has been an underappreciated complication in children with severe malaria. We conducted an individual patient data meta-analysis to model the impact of AKI and its complications on inpatient mortality in African children hospitalized with malaria. Methods Studies were identified using MEDLINE, EMBASE, Scopus, and PubMed with no language restrictions, as well as through outreach at scientific meetings. Investigators were contacted about participation in the study. Eligible studies included African children hospitalized with Plasmodium falciparum malaria, a serum creatinine measurement, and mortality assessed. The primary exposure was AKI, defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine. The primary outcome was all-cause in-hospital mortality, and dialysis requirement was a secondary outcome. Data were standardized and cleaned, and random-effects meta-analyses were conducted to generate pooled estimates. Results We included 18 studies involving 8 countries and 13,528 children aged 3 months to 16 years over a 33-year period with 951 deaths (7%). The frequency of KDIGO-defined AKI was 47% (95% confidence interval: 46% to 48%), with 47% of children having KDIGO-defined Stage 1 AKI, 30% having Stage 2, and 23% having Stage 3 AKI. Overall, KDIGO-defined AKI was associated with a 2.87 increased odds of mortality (95% CI 2.28 to 3.61) with a monotonic increase in mortality across AKI stage. AKI was a robust risk factor for mortality across era, sex, region, and subgroups. The KDIGO AKI definition was operationalized using simplified age-based thresholds to support bedside recognition of AKI with comparable mortality performance. The WHO-defined AKI threshold (creatinine value >3 mg/dL) occurred in 3.4% (238) of children. All 238 cases identified by WHO criteria were classified as having AKI using KDIGO and age-based definitions, but WHO missed 93% (3059/3297) of additional AKI cases. Conclusions AKI was strongly associated with mortality in African children hospitalized with malaria. Creatinine thresholds can be operationalized to facilitate early AKI recognition. These findings have clinical implications for the implementation of kidney-protective care and for enhanced monitoring of children with severe malaria. Other Funded by National Institutes of Health (1R01AI165946), registered number PROSPERO (CRD42024560012).
SN - 1741-7015
ER -