Acute kidney injury in patients with babesiosis: incidence, risk factors, clinical features, and outcomes
OA Version
Citation
Abstract
BACKGROUND: Babesiosis is an emerging tickborne illness caused by the intraerythrocytic parasite, Babesia microti, which is endemic in the northeastern U.S. Complications have been observed in >20% of hospitalized patients, though acute kidney injury (AKI) remains poorly described, with most data derived from case reports and small case series.
OBJECTIVES: We sought to characterize the incidence, severity, clinical features, risk factors, and outcomes associated with AKI, defined as a ≥50% increase in serum creatinine above baseline or receipt of kidney replacement therapy (KRT). We used multivariable logistic regression to identify independent risk factors for AKI.
METHODS: We reviewed the records of 1317 patients at Mass General Brigham with an ICD code or positive test result for Babesia between 2015-2023, of whom 272 (20.7%) were hospitalized. Among those hospitalized, we collected detailed data by manual chart review on demographics, comorbidities, medications, labs, and outcomes.
RESULTS: A total of 93 patients (34.2%) developed AKI, including 52 (55.9%), 23 (24.7%), and 18 (19.4%) with stages 1, 2, and 3, seven of whom (7.5%) received KRT. The most common etiologies of AKI were acute tubular necrosis (ATN), pre-renal azotemia, and hemolysis. Independent risk factors for AKI included older age, smoking, higher LDH, higher parasitemia load, and hematuria. Eight of 50 patients (16%) with data available had persistent kidney dysfunction at day 90.
CONCLUSIONS: In the largest study of babesiosis-associated AKI to date, we found that more than one third of hospitalized patients with babesiosis developed AKI, nearly half of which was moderate or severe (stage 2 or 3). We identified five independent risk factors for AKI, including markers of hemolysis and severity of parasitemia.
Description
2024