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

Meredith R Hickson1, Andrea L Conroy2, Paul Bangirana3

  • 1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.

Plos One
|December 18, 2019
PubMed

Insights

Acute kidney injury (AKI) in severe malaria is linked to long-term behavioral issues in older children. This study highlights the impact of AKI on executive function and behavior regulation in children aged six and above.

Area of Science:

  • Pediatric infectious diseases
  • Neuroscience
  • Nephrology

Background:

  • Severe malaria (SM) poses a risk for neurocognitive impairment.
  • The long-term behavioral effects of acute kidney injury (AKI) following SM remain unclear.

Purpose of the Study:

  • To investigate the association between AKI and long-term behavioral outcomes in children with severe malaria (cerebral malaria or severe malarial anemia).
  • To assess the impact of AKI on behavior and executive function over 24 months post-illness.

Main Methods:

  • A prospective study involving Ugandan children (1.5-12 years) with SM and healthy controls.
  • AKI defined by a 50% creatinine increase; behavior and executive function assessed using standardized checklists at multiple time points.
  • Linear mixed-effects models used to analyze the association between AKI and behavioral outcomes, adjusting for covariates.

Main Results:

  • AKI was present in 33.2% of SM patients at baseline.
  • Children aged ≥6 years with SM and AKI showed significantly worse outcomes in externalizing behaviors, global executive function, and behavioral regulation compared to those without AKI.
  • No significant behavioral differences were observed in children <6 years of age associated with AKI.

Conclusions:

  • Acute kidney injury is associated with persistent behavioral problems in children aged six and older who have experienced severe malaria.
  • These findings underscore the importance of monitoring and managing AKI in pediatric severe malaria cases to mitigate long-term behavioral sequelae.
Abstract

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