Reported Prevalence of Acute Kidney Injury in Severe Malaria: A Systematic Review and Meta-Analysis

Severe malaria remains a global public health challenge, and acute kidney injury (AKI) is a frequent and potentially lethal complication. Variability in diagnostic criteria has limited estimation of the reported burden, particularly in pediatric populations and endemic settings. This study synthesized evidence on the reported prevalence of AKI in patients with severe malaria, stratified by age group, geographic region, Plasmodium species, and diagnostic definition. A systematic review and meta-analysis was conducted following PRISMA guidelines. Six electronic databases (PubMed/MEDLINE, Scopus, Web of Science, EMBASE, LILACS, and SciELO) were searched from 1 January 2000 to 30 March 2026, complemented by manual reference screening. Observational studies in patients with severe malaria that reported AKI prevalence according to defined criteria were included. A random-effects meta-analysis of proportions was performed with subgroup analyses and meta-regression. Eleven studies including 3113 patients were included. The pooled reported prevalence of AKI was 39.6% (95% CI: 29.9–49.6%) in children and 33.4% (95% CI: 13.3–57.0%) in adult or adult-classified cohorts, with substantial heterogeneity (I2 >95%). Reported AKI prevalence increased across publication years in pediatric studies (ρ = 0.880, p < 0.01), a pattern likely reflecting greater diagnostic sensitivity and clinical awareness after adoption of Kidney Disease: Improving Global Outcomes (KDIGO) criteria rather than a proven biological increase. African studies reported higher prevalences (43.5%) than Asian studies (18.3%). AKI is frequently reported in severe malaria, but pooled estimates should be interpreted cautiously because heterogeneity was substantial and eligible studies were geographically concentrated. These findings support standardized renal assessment in severe malaria management and harmonized AKI definitions in future studies.