Kidney Replacement Therapy for Children With Acute Kidney Injury Due to Severe Malaria: A Review of Available Services in Selected African Countries

Acute kidney injury (AKI) is a common, life-threatening clinical complication of severe malaria in children associated with increased short- and long-term mortality. Malaria remains a leading cause of child mortality in Africa, where most severe malaria cases and deaths occur, and a few countries account for most of the global disease burden. While some children who develop severe malaria-associated AKI may require dialysis during hospitalization, survivors may require long-term care for chronic kidney disease, including maintenance dialysis and kidney transplant. There are variations in the availability and type of dialysis services offered across malaria-endemic African countries with major barriers to accessing kidney transplants. Access remains challenging among countries with dialysis services because these centers are usually located in selected specialized urban hospitals far from most patients. The limited number of available pediatric nephrologists in the region further impacts the delivery of specialized nephrology care. This review provides an overview of the magnitude of malaria-associated AKI in selected malaria-endemic countries, country-specific perspectives on dialysis availability and access, and kidney transplant services availability for children who develop chronic kidney disease.