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Meta-Analysis
. 2020 Nov 9;43(1):1-15.
doi: 10.1080/0886022X.2020.1847724.

Coronavirus-associated kidney outcomes in COVID-19, SARS, and MERS: a meta-analysis and systematic review

Shoulian Zhou  1 , Jing Xu  1 , Cheng Xue  1 , Bo Yang  2 , Zhiguo Mao  1 , Albert C M Ong  3   4
Affiliations
Meta-Analysis

Coronavirus-associated kidney outcomes in COVID-19, SARS, and MERS: a meta-analysis and systematic review

Shoulian Zhou et al. Ren Fail. .

Abstract

Objectives: A meta-analysis and systematic review was conducted on kidney-related outcomes of three recent pandemics: SARS, MERS, and COVID-19, which were associated with potentially fatal acute respiratory distress syndrome (ARDS).

Methods: A search of all published studies until 16 June 2020 was performed. The incidence/prevalence and mortality risk of acute and chronic renal events were evaluated, virus prevalence, and mortality in preexisting hemodialysis patients was investigated.

Results: A total of 58 eligible studies involving 13452 hospitalized patients with three types of coronavirus infection were included. The reported incidence of new-onset acute kidney injury (AKI) was 12.5% (95% CI: 7.6%-18.3%). AKI significantly increased the mortality risk (OR = 5.75, 95% CI 3.75-8.77, p < 0.00001) in patients with coronavirus infection. The overall rate of urgent-start kidney replacement therapy (urgent-start KRT) use was 8.9% (95% CI: 5.0%-13.8%) and those who received urgent-start KRT had a higher risk of mortality (OR = 3.43, 95% CI 2.02-5.85, p < 0.00001). Patients with known chronic kidney disease (CKD) had a higher mortality than those without CKD (OR = 1.97, 95% CI 1.56-2.49, p < 0.00001). The incidence of coronavirus infection was 7.7% (95% CI: 4.9%-11.1%) in prevalent hemodialysis patients with an overall mortality rate of 26.2% (95% CI: 20.6%-32.6%).

Conclusions: Primary kidney involvement is common with coronavirus infection and is associated with significantly increased mortality. The recognition of AKI, CKD, and urgent-start KRT as major risk factors for mortality in coronavirus-infected patients are important steps in reducing future mortality and long-term morbidity in hospitalized patients with coronavirus infection.

Keywords: COVID-19; MERS; SARS; kidney; outcome.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow chart of the diagram. SARS: severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; COVID-19: novel coronavirus disease 2019.
Figure 2.
Figure 2.
Mortality risk of AKI in three types of coronavirus diseases compared with non-AKI. AKI: acute kidney injury; SARS: severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; COVID-19: novel coronavirus disease 2019.
Figure 3.
Figure 3.
Mortality risk of urgent-start KRT use in three types of coronavirus diseases. Urgent-start KRT: urgent-start renal replacement therapy; MERS: Middle East respiratory syndrome; COVID-19: novel coronavirus disease 2019.
Figure 4.
Figure 4.
Mortality risk of non-dialytic preexisting CKD in three types of coronavirus diseases compared with non-CKD. CKD: chronic kidney disease; SARS: severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; COVID-19: novel coronavirus disease 2019.
Figure 5.
Figure 5.
Mortality risk of preexisting ESKD in three types of coronavirus diseases compared with non-ESKD. ESKD: end-stage renal disease; SARS: severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; COVID-19: novel coronavirus disease 2019.
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