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Meta-Analysis
. 2022 Oct-Dec;44(4):543-556.
doi: 10.1590/2175-8239-JBN-2022-0013en.

Acute kidney injury outcomes in covid-19 patients: systematic review and meta-analysis

[Article in English, Portuguese]
Beatriz Moreira Silva  1 , Letícia Cristina Silva De Assis  1 , Maurício De Castro Batista Júnior  1 , Naara Affonso Philipps Gonzalez  1 , Samuel Benni Dos Anjos  1 , Miguel Angelo Goes  2
Affiliations
Meta-Analysis

Acute kidney injury outcomes in covid-19 patients: systematic review and meta-analysis

[Article in English, Portuguese]
Beatriz Moreira Silva et al. J Bras Nefrol. 2022 Oct-Dec.

Abstract
in English, Portuguese

Background: Acute kidney injury (AKI) is a frequent complication of coronavirus-19 disease (COVID-19). Therefore, we decided to perform a systematic review and meta-analysis with data from the literature to relate the development of COVID-19 associated-AKI with comorbidities, medications, and the impact of mechanical ventilation.

Methods: We performed a systematic review using the Newcastle-Ottawa scale and a meta-analysis using the R program. Relevant studies were searched in the PubMed, Medline, and SciELO electronic databases. Search filters were used to include reports after 2020 and cohort studies.

Results: In total, 1166 articles were identified and 55 English-written articles were included based on the risk of bias. Of all COVID-19-hospitalized patients presenting with AKI (n = 18029) classified as Kidney Disease Improving Global Outcomes stage 1 to 3, approximately 18% required mechanical ventilation and 39.2 % died. Around 11.3% of the patients required kidney replacement therapy (KRT) and of these, 1093 died and 321 required continuous KRT. Death is more frequent in individuals with AKI [OR 6.03, 95%CI: 5.73-6.74; p<0.01]. Finally, mechanical ventilation is an aggravating factor in the clinical conditions studied [OR 11.01, 95%CI: 10.29-11.77; p<0.01].

Conclusion: Current literature indicates AKI as an important complication in COVID-19. In this context, we observed that comorbidities, such as chronic kidney disease and heart failure, were more related to the development of AKI. In addition, mechanical ventilation was seen as an aggravating factor in this scenario.

Antecedentes:: Lesão renal aguda (LRA) é uma complicação frequente da doença do coronavírus-19 (COVID-19). Desta forma, decidimos realizar uma revisão sistemática e uma metanálise com dados da literatura para relacionar o desenvolvimento de LRA associada à COVID-19 com comorbidades, medicamentos e o impacto da ventilação mecânica.

Métodos:: Realizamos uma revisão sistemática usando a escala de Newcastle-Ottawa e uma metanálise utilizando o programa R. Estudos relevantes foram pesquisados nos bancos de dados eletrônicos PubMed, Medline e SciELO. Foram utilizados filtros de pesquisa para incluir relatos após 2020 e estudos de coorte.

Resultados:: No total, foram identificados 1166 artigos, e foram incluídos 55 artigos escritos em língua inglesa com base no risco de viés. De todos os pacientes hospitalizados por COVID-19 apresentando LRA (n = 18029) classificados como Kidney Disease Improving Global Outcomes estágios 1 a 3, aproximadamente 18% necessitaram de ventilação mecânica e 39,2% foram a óbito. Cerca de 11,3% dos pacientes necessitaram de terapia renal substitutiva (TRS) e destes, 1093 foram a óbito e 321 necessitaram de TRS contínua. O óbito é mais frequente em indivíduos com LRA [OR 6,03; IC95%: 5,73-6,74; p<0,01]. Por fim, a ventilação mecânica é um fator agravante nas condições clínicas estudadas [OR 11,01; IC95%: 10,29-11,77; p<0,01].

Conclusão:: A literatura atual indica a LRA como uma complicação importante na COVID-19. Neste contexto, observamos que comorbidades, como doença renal crônica e insuficiência cardíaca, estiveram mais relacionadas ao desenvolvimento de LRA. Além disso, a ventilação mecânica foi vista como um fator agravante neste cenário.

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Conflict of interest statement

Conflict of Interest

The authors declare no competing interests.

Figures

Figure 1
Figure 1. Summary of evidence, search, and selection.
Figure 2
Figure 2. Comorbidities in patients with COVID-19 associated with acute kidney injury ,,,,,,,,,-,,-,- .
Figure 3
Figure 3. Drugs used in patients with COVID-19 ,,,,,,,,,-,,-,,- .
Figure 4
Figure 4. Forest plot of the association of acute kidney injury and number of deaths.
Figure 5
Figure 5. Forest plot of the association of mechanical ventilation and acute kidney injury.
See this image and copyright information in PMC

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