tetano
Editor, Senior Moderator
Clin Kidney J
. 2020 Sep 2;13(4):550-563.
doi: 10.1093/ckj/sfaa160. eCollection 2020 Aug.
Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis
Edouard L Fu[SUP] 1 [/SUP], Roemer J Janse[SUP] 1 [/SUP], Ype de Jong[SUP] 1 2 [/SUP], Vera H W van der Endt[SUP] 1 [/SUP], Jet Milders[SUP] 1 [/SUP], Esmee M van der Willik[SUP] 1 [/SUP], Esther N M de Rooij[SUP] 1 2 [/SUP], Olaf M Dekkers[SUP] 1 2 3 [/SUP], Joris I Rotmans[SUP] 2 [/SUP], Merel van Diepen[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients.
Methods: We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity.
Results: A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8-39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1-7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1-11.4; 18 studies) and 2.2% (95% CI 1.5-3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7-26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3-6.5).
Conclusions: AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; kidney replacement therapy; meta-analysis.
. 2020 Sep 2;13(4):550-563.
doi: 10.1093/ckj/sfaa160. eCollection 2020 Aug.
Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis
Edouard L Fu[SUP] 1 [/SUP], Roemer J Janse[SUP] 1 [/SUP], Ype de Jong[SUP] 1 2 [/SUP], Vera H W van der Endt[SUP] 1 [/SUP], Jet Milders[SUP] 1 [/SUP], Esmee M van der Willik[SUP] 1 [/SUP], Esther N M de Rooij[SUP] 1 2 [/SUP], Olaf M Dekkers[SUP] 1 2 3 [/SUP], Joris I Rotmans[SUP] 2 [/SUP], Merel van Diepen[SUP] 1 [/SUP]
Affiliations
- PMID: 32897278
- PMCID: PMC7467593
- DOI: 10.1093/ckj/sfaa160
Abstract
Background: Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients.
Methods: We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity.
Results: A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8-39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1-7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1-11.4; 18 studies) and 2.2% (95% CI 1.5-3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7-26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3-6.5).
Conclusions: AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; kidney replacement therapy; meta-analysis.