A Study Using Point-of-Care Creatinine Testing in a Nigerian Primary Health Care Centre: Malaria as the Leading Cause of Acute Kidney Injury Particularly in Children.

<p>Background: Acute kidney injury (AKI) worsens outcomes in low- and middle-income countries, largely due to delayed diagnosis and limited access to renal replacement therapy. Its true epidemiology remains unclear, partly due to delayed biochemical testing. In a prior phase of our work, we evaluated point-of-care creatinine (POC Cr) technology and its use in implementing a clinical algorithm to select patients at risk of AKI in a Nigerian hospital emergency department. In this study, POC Cr was used in a large primary care health center in Nigeria.

methodsThe study was conducted at Ozuoba Model Comprehensive Primary Health Care Centre in Nigeria, where renal function tests are rarely available and external laboratory results typically take over 48 h. POC Cr testing was introduced for high-risk adults using the clinical algorithm developed in the previous phase of this programme and for children with suspected severe illness based on clinical judgement or reduced urine output. Adjusted POC Cr values were calculated (POC Cr - 27.2 µmol/L), and AKI was staged using KDIGO criteria, with baseline creatinine defined as 100 µmol/L for adults and age-specific norms for children.

resultsA total of 424 patients were tested using POC Cr, comprising 301 adults and 123 children. Malaria was the most frequent diagnosis, accounting for 293 cases (61.1%). The median adjusted POC Cr across the entire cohort was 72.8 µmol/L (interquartile range [IQR]: 36). Among adult patients, AKI was diagnosed in 2 out of the 301 individuals (0.6%), one stage 1 and one stage 2, both of whom had malaria. In the paediatric group, the median age was 5 years (IQR: 7), with females comprising 65% of the cohort. Malaria was diagnosed in 69.9% of the children. AKI was identified in 70 out of 123 children (56.9%), with AKI stage 1 in 25 (20.3%), stage 2 in 26 (21.2%), and stage 3 in 19 children (15.4%). Among the 70 paediatric AKI cases, 49 (70%) had malaria. The highest prevalence of AKI was seen in children under 5 years of age, with the incidence declining steadily and reaching zero beyond age 12.

conclusionOur study found that more than half of paediatric patients diagnosed with malaria at a primary health care level had AKI, highlighting AKI as a common complication of malaria in young children. These findings emphasise the need for further research to support informed potential updates to WHO malaria treatment guidelines to incorporate the KDIGO definition of AKI, particularly in the context of paediatric care in low-resource settings. </p>.