Treatment of malarial acute renal failure by hemodialysis

We studied 112 patients with malarial acute renal failure (ARF) during the period 1991-1997 at Bangkok Hospital for Tropical Diseases (Mahidol Univers ity,Bangkok, Thailand). Hemodialysis was performed in 101 (90.2%) of these patients. The mean number of times the patients were hemodialyzed was 6.5 ( range = 1-27). Ninety-three (83.0%) patients were oliguric and the remainde r were nonoliguric. Patients who had oliguric renal failure required more h emodialyses and had more complications than the nonoliguric patients. The o liguric patients had an eight-fold higher risk of requiring six or more hem odialyses (95% confidence interval = 1.2-53.9, P = 0.0008). The overall mor tality rate was 10.7% (12 of 112). Eleven of the patients who died were jau ndiced and eight of them had cerebral malaria with a Glasgow Coma Score les s than or equal to 8. We conclude that hemodialysis is a useful treatment f or oliguric and nonoliguric ARF from severe malaria, particularly when init iated early in the course of the illness.