There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality ( p<0.0001 for all). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R 2 values of 0.95 and 0.93 respectively however, the correlation was significantly lower in children with creatinine values <1mg/dL (R 2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The mean age of children was 2.1 years, and 21.6% of children were stunted. AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. However, LMIC-particularly countries in sub-Saharan Africa- are under-represented in global AKI research. Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC).
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