Publication: Laboratory prediction of the requirement for renal replacement in acute falciparum malaria.
1
Accepted Date
2011-08-03
Issued Date
2011-08-03
Copyright Date
2011
Resource Type
Language
eng
ISSN
1475-2875 (electronic)
Rights Holder(s)
BioMed Central
Bibliographic Citation
Hanson J, Hasan MM, Royakkers AA, Alam S, Charunwatthana P, Maude RJ. et al. Laboratory prediction of the requirement for renal replacement in acute falciparum malaria. Malar J. 2011 Aug 3;10:217.
Suggested Citation
Hanson, Josh, Hasan, Md Mahtab Uddin, Royakkers, Annick A, Alam, Shamsul, Prakaykaew Charunwatthana, ประกายแก้ว จรูญวรรธนะ, Maude, Richard J, Douthwaite, Sam T, Yunus, Emran Bin, Mantha, Murty L, Schultz, Marcus J, Faiz, M Abul, White, Nicholas J, Day, Nicholas P, Dondorp, Arjen M Laboratory prediction of the requirement for renal replacement in acute falciparum malaria.. Hanson J, Hasan MM, Royakkers AA, Alam S, Charunwatthana P, Maude RJ. et al. Laboratory prediction of the requirement for renal replacement in acute falciparum malaria. Malar J. 2011 Aug 3;10:217.. doi:10.1186/1475-2875-10-217 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/816
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Title
Laboratory prediction of the requirement for renal replacement in acute falciparum malaria.
Corresponding Author(s)
Abstract
BACKGROUND: Acute renal failure is a common complication of severe malaria in
adults, and without renal replacement therapy (RRT), it carries a poor prognosis.
Even when RRT is available, delaying its initiation may increase mortality.
Earlier identification of patients who will need RRT may improve outcomes.
METHOD: Prospectively collected data from two intervention studies in adults with
severe malaria were analysed focusing on laboratory features on presentation and
their association with a later requirement for RRT. In particular, laboratory
indices of acute tubular necrosis (ATN) and acute kidney injury (AKI) that are
used in other settings were examined.
RESULTS: Data from 163 patients were available for analysis. Whether or not the
patients should have received RRT (a retrospective assessment determined by three
independent reviewers) was used as the reference. Forty-three (26.4%) patients
met criteria for dialysis, but only 19 (44.2%) were able to receive this
intervention due to the limited availability of RRT. Patients with impaired renal
function on admission (creatinine clearance < 60 ml/min) (n = 84) had their
laboratory indices of ATN/AKI analysed. The plasma creatinine level had the
greatest area under the ROC curve (AUC): 0.83 (95% confidence interval
0.74-0.92), significantly better than the AUCs for, urinary sodium level, the
urea to creatinine ratio (UCR), the fractional excretion of urea (FeUN) and the
urinary neutrophil gelatinase-associated lipocalcin (NGAL) level. The AUC for
plasma creatinine was also greater than the AUC for blood urea nitrogen level,
the fractional excretion of sodium (FeNa), the renal failure index (RFI), the
urinary osmolality, the urine to plasma creatinine ratio (UPCR) and the
creatinine clearance, although the difference for these variables did not reach
statistical significance.
CONCLUSIONS: In adult patients with severe malaria and impaired renal function on
admission, none of the evaluated laboratory indices was superior to the plasma
creatinine level when used to predict a later requirement for renal replacement
therapy.