Acute Kidney Injury (AKI) in Severe Plasmodium falciparum Malaria Among Adult Sudanese Patients in Kosti Teaching Hospital, 2025.

Background Acute kidney injury (AKI) is a frequent and serious complication of severe malaria (SM), contributing significantly to morbidity and mortality. In endemic regions like Sudan, AKI complicates the clinical course of SM, yet detailed demographic, clinical, and outcome data remain limited. Aim This study aimed to characterize the demographic profile, clinical features, management strategies, and outcomes of AKI in patients with SM in Sudan. Methods A cross-sectional analysis of 100 SM patients with AKI was conducted in Kosti Teaching Hospital from February to May 2025. Data on demographics, comorbidities, malaria complications, AKI severity (classified via Kidney Disease: Improving Global Outcomes (KDIGO) criteria), treatment regimens, contributing factors, interventions, and outcomes were collected from medical records. The statistical analysis was performed using SPSS (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). Results Patients were predominantly male (64 (64%)) with a mean age of 48 years (SD 22); 43 (43%) were under 40 years of age. Central Sudan residents comprised 67 (67%) of cases. Hyperparasitemia (92 (92%)), circulatory shock (58 (58%)), and prostration (44 (44%)) were frequent complications. Hypertension (36 (36%)) and diabetes (20 (20%)) were leading comorbidities. Artesunate was the primary treatment (68 (68%)). AKI severity included Stage 1 (44 (44%)), Stage 2 (28 (28%)), and Stage 3 (28 (28%)). Hypovolemia (95 (95%)) and sepsis (63 (63%)) were key contributors. Interventions included IV fluids (94 (94%)) and antibiotics (74 (74%)). Outcomes revealed full renal recovery in 55 (55%), partial recovery in 28 (28%), progression to chronic kidney disease in 13 (13%), and a four (4%) mortality rate. Conclusion SM-associated AKI in Sudan predominantly affects younger people as well as males and is frequently linked to hyperparasitemia, circulatory shock, and comorbid hypertension. Despite high rates of severe AKI, over half of patients achieve full renal recovery with appropriate treatment, though a notable proportion progress to chronic kidney disease or die.