INDIANAPOLIS — A new study from Indiana University School of Medicine researchers and their global health collaborators reveals that acute kidney injury (AKI) is associated with a three-times-higher risk of death following cases of severe malaria. The findings, recently published in The Lancet Global Health, emphasize the need for better testing and follow-up care in regions with high-risk malaria populations to avoid preventable deaths.
"Children who experienced AKI had more than a threefold higher risk of death over follow-up, and this increased risk persisted years after the initial illness," said Andrea Conroy, PhD, associate professor of pediatrics at the IU School of Medicine and senior author on the study. "Nearly half of all deaths occurred after hospital discharge."
AKI, which occurs when the kidneys lose the ability to function properly, affects about 60% of children with severe malaria, the life-threatening form of the infectious disease. In the study, researchers followed over 1,000 Ugandan children for up to 15 years after hospitalizations caused by severe malaria to examine their kidney health and survival outcomes.
The team's discovery of a tripled death risk presented a stark contrast to the long-held belief that chronic kidney disease (CKD) is the most notable long-term outcome of the condition. They noticed that in high-income countries, children with AKI have better access to testing, kidney care and post-hospitalization follow-up. However, that was not the case in low- and middle-income countries.
"These findings suggest that the long-term consequences of AKI may differ substantially depending on where children live," Conroy said. "In high-income settings, AKI is increasingly linked to CKD and other chronic complications. In our setting, mortality appears to be the dominant long-term outcome."
Future studies from the group will focus on better understanding why some children have increased mortality risk following AKI. The goal is to identify high-risk children before they leave the hospital and give them treatments that can improve their kidney health and ultimately save lives.
Conroy, a researcher at the Ryan White Center for Pediatric Infectious Diseases and Global Health and the Herman B Wells Center for Pediatric Research, was also part of a study recently published in the Journal of the American Medical Association (JAMA) that examined the same cohort of Ugandan children. That study revealed children who survive cases of cerebral malaria and severe malarial anemia experience cognitive and academic impairment that persists into adolescence. The two studies underscore the long-term significance of one of the world’s deadliest diseases.
"Together, the studies suggest that severe malaria can have lasting consequences that extend far beyond the initial illness, affecting both long-term survival and cognitive and educational outcomes," Conroy said.
IU School of Medicine's Kagan Mellencamp, Claire Liepmann, Michael Goings, Dibyadyuti Datta, Jie Ren and Chandy John are co-authors on the study. Additional co-authors include Ruth Namazzi, Anthony Batte, Caroline Kazinga, Robert Opoka and Paul Bangirana of Global Health Uganda; Robert Kalyesubula of Makerere University College of Health Sciences; and Stuart Goldstein of University of Cincinnati College of Medicine.
This research was supported by funding from the National Institutes of Health.
About the Indiana University School of Medicine
The IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. According to the Blue Ridge Institute for Medical Research, the IU School of Medicine ranks No. 15 in 2025 National Institutes of Health funding among all public medical schools in the country.
Writer: Jackie Maupin, jacmaup@iu.edu
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