COVID–19 and chronic kidney disease: an updated overview of reviews

Abstract

Background Coronavirus disease (COVID–19) has resulted in the death of more than 3.5 million people worldwide. While COVID–19 mostly affects the lungs, different comorbidities can have an impact on its outcomes. We performed an overview of reviews to assess the effect of Chronic Kidney Disease (CKD) on contracting COVID–19, hospitalization, mortality, and disease severity. Methods We searched published and preprint databases. We updated the reviews by searching for primary studies published after August 2020, and prioritized reviews that are most updated and of higher quality using the AMSTAR tool. Results We included 69 systematic reviews and 66 primary studies. Twenty-eight reviews reported on the prevalence of CKD among patients with COVID–19, which ranged from 0.4 to 49.0%. One systematic review showed an increased risk of hospitalization in patients with CKD and COVID–19 (RR = 1.63, 95% CI 1.03–2.58) (Moderate certainty). Primary studies also showed a statistically significant increase of hospitalization in such patients. Thirty-seven systematic reviews assessed mortality risk in patients with CKD and COVID–19. The pooled estimates from primary studies for mortality in patients with CKD and COVID–19 showed a HR of 1.48 (95% CI 1.33–1.65) (Moderate certainty), an OR of 1.77 (95% CI 1.54–2.02) (Moderate certainty) and a RR of 1.6 (95% CI 0.88–2.92) (Low certainty). Conclusions Our review highlights the impact of CKD on the poor outcomes of COVID–19, underscoring the importance of identifying strategies to prevent COVID–19 infection among patients with CKD. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01206-8.

National early warning score (NEWS) 2 predicts hospital mortality from COVID-19 patients

“…Based on previous studies, CKD increases the risk of mortality for COVID-19 patients by 5.81 times as the level of pro-inflammatory cytokines increases in CKD patients, causing an increase in oxidative stress which ultimately results in an immune-inflammatory response. The resulting immune system damage may increase susceptibility to bacterial and viral infections, and this may be the main reason for the increased risk of pulmonary inflammation [ 19 , 20 ]. Based on previous research, it was stated that T2DM had a significant relationship with the mortality of COVID-19 patients, where T2DM patients infected with COVID-19 had a mortality risk of 1.75 [ 21 ].…”

Cardiorenal Disease in COVID-19 Patients

“…showed that about 20% of patients with kidney disease and comorbidity had a 3-fold higher risk of contracting viral infection than those without CKD. Furthermore, patients with acute kidney injury (AKI) who tested positive for COVID-19 had a higher risk of CKD [ 44 ] than those who did not have AKI [ 45 ], recognizing CKD plays a key role in the severity of COVID-19.…”

Mechanisms of Cardiovascular System Injury Induced by COVID-19 in Elderly Patients With Cardiovascular History

“…The incidence of CKD increases with age, and 38% of the patients with CKD are more than 65 years old ( 77 ). Cardiovascular causes are recognized as the leading cause of death, accounting for 50%of the mortality in the CKD population ( 78 ).…”

“…Therefore, it is of great importance to investigate the cardiovascular injuries in the elderly with CKD induced by the pandemic COVID-19 infection. A comprehensive review reveals the effect of CKD on increased hospitalization and mortality of COVID-19, perhaps owing to immune dysfunction and increased susceptibility to infections ( 77 , 79 ).…”