tetano
Editor, Senior Moderator
Am J Kidney Dis
. 2021 Aug 5;S0272-6386(21)00771-X.
doi: 10.1053/j.ajkd.2021.07.003. Online ahead of print.
Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis
Edmund Ym Chung[SUP] 1 [/SUP], Suetonia C Palmer[SUP] 2 [/SUP], Patrizia Natale[SUP] 3 [/SUP], Anoushka Krishnan[SUP] 4 [/SUP], Tess E Cooper[SUP] 5 [/SUP], Valeria M Saglimbene[SUP] 6 [/SUP], Marinella Ruospo[SUP] 3 [/SUP], Eric Au[SUP] 7 [/SUP], Sumedh Jayanti[SUP] 8 [/SUP], Amy Liang[SUP] 9 [/SUP], Danny Jia Jie Deng[SUP] 9 [/SUP], Juanita Chui[SUP] 9 [/SUP], Gail Y Higgins[SUP] 10 [/SUP], Allison Tong[SUP] 11 [/SUP], Germaine Wong[SUP] 12 [/SUP], Armando Teixeira-Pinto[SUP] 11 [/SUP], Elisabeth M Hodson[SUP] 10 [/SUP], Jonathan C Craig[SUP] 13 [/SUP], Giovanni Fm Strippoli[SUP] 3 [/SUP]
Affiliations
Abstract
Rationale & objective: Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD.
Study design: Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021.
Setting & study populations: People with CKD with or without COVID-19.
Selection criteria for studies: Cohort and case-control studies.
Data extraction: Incidence of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue.
Analytical approach: Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Results: 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) and kidney or pancreas-kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher compared to people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants).
Limitations: Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19 and potential confounders were not adjusted for in most studies.
Conclusions: The incidence of COVID-19 may be higher in people receiving maintenance dialysis compared to those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas-kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.
Keywords: Coronavirus disease 2019 (COVID-19); chronic kidney disease (CKD); cohort studies; dialysis patients; end-stage kidney disease (ESKD); incidence; meta-analysis; mortality; prognosis; respiratory failure; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); systematic review.
. 2021 Aug 5;S0272-6386(21)00771-X.
doi: 10.1053/j.ajkd.2021.07.003. Online ahead of print.
Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis
Edmund Ym Chung[SUP] 1 [/SUP], Suetonia C Palmer[SUP] 2 [/SUP], Patrizia Natale[SUP] 3 [/SUP], Anoushka Krishnan[SUP] 4 [/SUP], Tess E Cooper[SUP] 5 [/SUP], Valeria M Saglimbene[SUP] 6 [/SUP], Marinella Ruospo[SUP] 3 [/SUP], Eric Au[SUP] 7 [/SUP], Sumedh Jayanti[SUP] 8 [/SUP], Amy Liang[SUP] 9 [/SUP], Danny Jia Jie Deng[SUP] 9 [/SUP], Juanita Chui[SUP] 9 [/SUP], Gail Y Higgins[SUP] 10 [/SUP], Allison Tong[SUP] 11 [/SUP], Germaine Wong[SUP] 12 [/SUP], Armando Teixeira-Pinto[SUP] 11 [/SUP], Elisabeth M Hodson[SUP] 10 [/SUP], Jonathan C Craig[SUP] 13 [/SUP], Giovanni Fm Strippoli[SUP] 3 [/SUP]
Affiliations
- PMID: 34364906
- DOI: 10.1053/j.ajkd.2021.07.003
Abstract
Rationale & objective: Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD.
Study design: Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021.
Setting & study populations: People with CKD with or without COVID-19.
Selection criteria for studies: Cohort and case-control studies.
Data extraction: Incidence of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue.
Analytical approach: Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Results: 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) and kidney or pancreas-kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher compared to people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants).
Limitations: Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19 and potential confounders were not adjusted for in most studies.
Conclusions: The incidence of COVID-19 may be higher in people receiving maintenance dialysis compared to those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas-kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.
Keywords: Coronavirus disease 2019 (COVID-19); chronic kidney disease (CKD); cohort studies; dialysis patients; end-stage kidney disease (ESKD); incidence; meta-analysis; mortality; prognosis; respiratory failure; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); systematic review.