There are limited data on the application of the RIFLE criteria among patients with severe malaria. This retrospective study was conducted by reviewing 257 medical records of adult hospitalized patients with severe falciparum malaria at the Mae Sot General Hospital, Tak province in the northern part of Thailand. The aims of this study were to determine the incidence of acute renal failure (ARF) in patients with severe falciparum malaria and its association with RRT as well as in-hospital mortality. Using the WHO 2006 criteria, ARF was the second most common complication with incidence of 44.7% (115 patients). The requirement for RRT was 45.2% (52 patients) and the in-hospital mortality was 31.9% (36 patients). Using the RIFLE criteria, 73.9% (190 patients) had acute kidney injury (AKI). The requirement for RRT was 11.6% (5 patients) in patients with RIFLE-I and 44.9% (48 patients) in patients with RIFLE-F. The in-hospital mortality gradually increased with the severity of AKI. The requirement for RRT ( ) and the in-hospital mortality ( ) were significantly higher in ARF patients with severe falciparum malaria using both criteria. In conclusion, the RIFLE criteria could be used for diagnosing AKI and predicting outcomes in patients with severe malaria similar to the WHO 2006 criteria. 1. Introduction Malaria is caused by protozoan parasites of the genus Plasmodium, namely, P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi. Patients with P. falciparum infection are prone to develop severe malaria in 30% of cases [1], which resulted in case fatality rate of 20% [2]. In Southeast Asia, acute renal failure (ARF) is one of the most common complications in adults with falciparum malaria [3, 4]. The incidence of ARF in patients with severe malaria varies widely ranging from 15% to 48% [5–11] which resulted in a high fatality rate of over 70% in untreated patients [12]. The availability of renal replacement therapy (RRT) and appropriate antimalarial chemotherapy has been shown to reduce case fatality rate as well as enhance the recovery of renal function [13, 14]. Recently, a few observational studies demonstrated that there was an increased risk for mortality with small increments in serum creatinine; this finding made the case for the adoption of more sensitive creatinine-based criteria for acute kidney injury (AKI) [15, 16]. The term ARF was replaced by AKI which was classified as the risk, injury, failure, loss, and end-stage renal failure criteria (RIFLE criteria) proposed by the Acute Dialysis Quality Initiative (ADQI) Group [17]. In
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