OUTCOME OF HAEMODIALYSIS IN ACUTE RENAL FAILURE DUE TO MALARIA: A SINGLE CENTRE STUDY

Objective: This study was conducted to find out the outcome of haemodialysis in patients with acute renal failure secondary to malaria.Materia! and Methods: This study was conducted at District Teaching Hospital, Dera Ismail Khan, from January 2004 to December 2004. Patients with acute renal failure secondary to malaria, not responding to fluid challenge and frusemide for twenty-four hours and requiring haemodialysis were finally selected for the study, All these patients were haemodialysed after the requisite workup. Standard antimalarial therapy was continued during haemodialysis.Results: Out of twenty patients (II females, 9 males), 16 patients (80%) were positive for Plasmodium Falciparum and 4 (20%) were positive for Vivax malaria. The mean blood urea was IlOmg/dl and mean serum creatinine was 6.5mg/dl. The other complications of malaria were hypotension (60%), cerebral malaria (20%), intravascular haemolysis and disseminated intravascular coagulation (10% each). The overall mortality was 20% (n=4/20). The patients who survived differed only in timing of referral from the initial diagnosis (mean 2 days for patients who survived and mean 4 days for patients who died) and evidence of intravascular haemolysis (mean bilirubin of 4.50 mg/dl for those who survived versus 8.50 mg/dl of those who died). Two patients, who had developed disseminated intravascular coagulation, could not survive.Conclusion: In acute renal failure complicating malaria, early referral and early haemodialysis has good results in reducing mortality. Haemodialysis along with active treatment with antimalarial has an excellent response in these patients if administered timely.