Abstract
<title>Abstract</title> <p> <bold>Background</bold> : Malaria-associated acute kidney injury (MAKI) is a severe complication of malaria with significant morbidity and mortality, particularly in resource-limited settings. However, despite this considerable burden, data from Ethiopia are scarce. <bold>Objective:</bold> To assess the clinical characteristics and short-term outcomes of MAKI and identify predictors of poor outcomes among adult patients admitted to Jimma University Medical Center (JUMC). <bold>Methods:</bold> A hospital-based prospective observational study was conducted from April 2025 to March 2026 at JUMC. A total of 186 adult patients (≥16 years) with confirmed malaria and acute kidney injury were included. Data were collected using a structured questionnaire and analyzed using SPSS version 27. Multivariable logistic regression was performed to identify factors associated with poor clinical outcomes. Statistical significance was set at p < 0.05. <bold>Results:</bold> The mean age of participants was 29 ± 14.14 years, with a female predominance of 51.6% and most patients came from rural area (69.4%). The most common presenting symptoms were fever (97.8%), chills (97.8%), nausea/vomiting (77.9%), and decreased urine output (73.7%). <italic>Plasmodium falciparum</italic> accounted for 50% of infections, while mixed infections of <italic>plasmodium falciparum and plasmodium vivax</italic> comprised 37.1%. At discharge, 66.1% of patients had complete renal recovery, 16.1% had partial recovery, and 11.3% died. Multivariable analysis identified low systolic blood pressure (AOR = 10.1, 95% CI: 1.58–68.62), severe anemia (AOR = 2.76, 95% CI: 1.18–6.46), severe azotemia (AOR = 15.5, 95% CI: 5.35–44.8), hyponatremia (AOR = 2.45, 95% CI: 1.07–5.62), elevated procalcitonin (AOR = 2.88, 95% CI: 1.14–7.24), and cerebral malaria (AOR = 5.2, 95% CI: 1.8–15.04) as independent predictors of poor outcomes. <bold>Conclusion:</bold> Approximately One-third of patients with MAKI experienced poor clinical outcome, reflecting asubstantial burden of morbidity and mortality. Early recognition of high risk patients particularly those with hypotension, severe anemia, electrolyte abnormalities, and cerebral malaria, may improve clinical outcomes. </p>