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. 2020 Jun 25;5(8):1149-1160.
doi: 10.1016/j.ekir.2020.06.013. eCollection 2020 Aug.

Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

Shelief Y Robbins-Juarez  1 , Long Qian  1   2 , Kristen L King  1   2   3 , Jacob S Stevens  1   2 , S Ali Husain  1   2 , Jai Radhakrishnan  1 , Sumit Mohan  1   2   3
Affiliations

Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

Shelief Y Robbins-Juarez et al. Kidney Int Rep. .

Abstract

Introduction: There are limited data on the association of kidney dysfunction with prognosis in coronavirus disease 2019 (COVID-19), and the extent to which acute kidney injury (AKI) predisposes patients to severe illness and inferior outcomes is unclear. We aim to assess the incidence of AKI among patients with COVID-19 and examine their associations with patient outcomes as reported in the available literature thus far.

Methods: We systematically searched MEDLINE, EMBASE, SCOPUS, and MedRxiv databases for full-text articles available in English published from December 1, 2019 to May 24, 2020. Clinical information was extracted and examined from 20 cohorts that met inclusion criteria, covering 13,137 mostly hospitalized patients confirmed to have COVID-19. Two authors independently extracted study characteristics, results, outcomes, study-level risk of bias, and strength of evidence across studies. Neither reviewer was blind to journal titles, study authors, or institutions.

Results: Median age was 56 years, with 55% male patients. Approximately 43% of patients had severe COVID-19 infection, and approximately 11% died. Prevalence of AKI was 17%; 77% of patients with AKI experienced severe COVID-19 infection, and 52% died. AKI was associated with increased odds of death among COVID-19 patients (pooled odds ratio, 15.27; 95% CI 4.82-48.36), although there was considerable heterogeneity across studies and among different regions in the world. Approximately 5% of all patients required use of renal replacement therapy (RRT).

Conclusions: Kidney dysfunction is common among patients with COVID-19, and patients who develop AKI have inferior outcomes. Additional research into management and potential mechanisms of this association is needed.

Keywords: COVID-19; acute kidney injury; meta-analysis; mortality; renal replacement therapy; systematic review.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses search flowsheet. AKI, acute kidney injury; KDIGO, Kidney Disease: Improving Global Outcomes.
Figure 2
Figure 2
Odds ratios (ORs) of acute kidney injury (AKI) and death, stratified by geographic location of patient cohorts. CI, confidence interval.
Figure 3
Figure 3
Odds ratios (ORs) of acute kidney injury (AKI) and death, stratified by proportion of patients with severe disease or intensive care unit admission. CI, confidence interval.
Figure 4
Figure 4
Odds ratios (ORs) of acute kidney injury (AKI) and death, stratified by preprint versus peer-reviewed studies. CI, confidence interval.
Figure 5
Figure 5
Funnel plot of studies reporting mortality associated with acute kidney injury.
See this image and copyright information in PMC

Comment in

  • Six Years of KI Reports: Milestones Behind and Ahead.
    McLean R, Mohan S, Radhakrishnan J. McLean R, et al. Kidney Int Rep. 2021 Dec 6;7(1):1-2. doi: 10.1016/j.ekir.2021.11.030. eCollection 2022 Jan. Kidney Int Rep. 2021. PMID: 35005305 Free PMC article. No abstract available.

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