Clinical characteristics and outcome of malaria-associated acute kidney injury in adult patients: a systematic review and meta analysis

Malaria-associated acute kidney injury (MAKI) represents a severe complication of malaria, increasingly documented in both Plasmodium falciparum and Plasmodium vivax infections across endemic regions. A systematic review and metaanalysis using PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify studies published between 2000 and 2024. This review evaluates the existing literature on MAKI in adult population, aiming to synthesize data on demographics, Plasmodium species, kidney involvement, dialysis need, mortality, kidney histopathology, and long-term kidney outcomes. The review included 25 studies with 2,094 MAKI patients predominantly from South Asia, especially India followed by Pakistan and Thailand. Plasmodium falciparum was the most common species implicated, though severe AKI due to P. vivax was increasingly reported. AKI definitions varied, using serum creatinine thresholds or classifications like KDIGO, RIFLE, and WHO. The incidence of MAKI ranged from 2.4 to 45.5%, rising to as high as 77% among patients with severe malaria. The pooled incidence of AKI among adults patients with malaria was 26.5% (95% CI 19.8–34.4; I 2 = 97%). Dialysis was required in 20–90% of cases. The mean creatinine ranged from 1.5 to over 10 mg/dL. The pooled mortality among adults MAKI patients was 19.2% (95% CI 12.9–27.7%). Mortality varied from 5 to 52%, higher in cases with delayed presentation, cerebral malaria, sepsis, need for mechanical ventilation, metabolic acidosis, and multiorgan failure. Among 95 biopsied cases, acute tubular necrosis was most common but vascular injuries like thrombotic microangiopathy and acute cortical necrosis were strongly associated with P. vivax . Long-term data were limited, but 5–20% of patients developed chronic kidney disease or kidney failure. Sub-Saharan Africa remained underrepresented despite its high malaria burden. MAKI is a severe complication of malaria with regional variation in species, outcomes, and care access. Improved diagnostics, timely dialysis, and long-term nephrology follow-up are essential in endemic regions.