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. 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  1 , Roemer J Janse  1 , Ype de Jong  1   2 , Vera H W van der Endt  1 , Jet Milders  1 , Esmee M van der Willik  1 , Esther N M de Rooij  1   2 , Olaf M Dekkers  1   2   3 , Joris I Rotmans  2 , Merel van Diepen  1
Affiliations

Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis

Edouard L Fu et al. Clin Kidney J. .

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.

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Figures

FIGURE 1:
FIGURE 1:
Incidence of AKI (%) among hospitalized COVID-19 patients stratified by geographic location.
FIGURE 1:
FIGURE 1:
Incidence of AKI (%) among hospitalized COVID-19 patients stratified by geographic location.
FIGURE 2:
FIGURE 2:
Incidence of KRT (%) among hospitalized COVID-19 patients stratified by geographic location.
FIGURE 2:
FIGURE 2:
Incidence of KRT (%) among hospitalized COVID-19 patients stratified by geographic location.
FIGURE 3:
FIGURE 3:
Incidence of AKI (%) among COVID-19 patients admitted to the ICU.
FIGURE 4:
FIGURE 4:
Incidence of KRT (%) among COVID-19 patients admitted to the ICU.
See this image and copyright information in PMC

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