Global REnal Involvement of CORonavirus Disease 2019 (RECORD): A Systematic Review and Meta-Analysis of Incidence, Risk Factors, and Clinical Outcomes

Abstract

Introduction: The quantitative effect of underlying non-communicable diseases on acute kidney injury (AKI) incidence and the factors affecting the odds of death among coronavirus disease 2019 (COVID-19) AKI patients were unclear at population level. This study aimed to assess the association between AKI, mortality, underlying non-communicable diseases, and clinical risk factors.Methods: A systematic search of six databases was performed from January 1, 2020, until October 5, 2020. Peer-reviewed observational studies containing quantitative data on risk factors and incidence of renal manifestations of COVID-19 were included. Location, institution, and time period were matched to avoid duplicated data source. Incidence, prevalence, and odds ratio of outcomes were extracted and pooled by random-effects meta-analysis. History of renal replacement therapy (RRT) and age group were stratified for analysis. Univariable meta-regression models were built using AKI incidence as dependent variable, with underlying comorbidities and clinical presentations at admission as independent variables.Results: Global incidence rates of AKI and RRT in COVID-19 patients were 20.40% [95% confidence interval (CI) = 12.07–28.74] and 2.97% (95% CI = 1.91–4.04), respectively, among patients without RRT history. Patients who developed AKI during hospitalization were associated with 8 times (pooled OR = 9.03, 95% CI = 5.45–14.94) and 16.6 times (pooled OR = 17.58, 95% CI = 10.51–29.38) increased odds of death or being critical. At population level, each percentage increase in the underlying prevalence of diabetes, hypertension, chronic kidney disease, and tumor history was associated with 0.82% (95% CI = 0.40–1.24), 0.48% (95% CI = 0.18–0.78), 0.99% (95% CI = 0.18–1.79), and 2.85% (95% CI = 0.93–4.76) increased incidence of AKI across different settings, respectively. Although patients who had a kidney transplant presented with a higher incidence of AKI and RRT, their odds of mortality was lower. A positive trend of increased odds of death among AKI patients against the interval between symptom onset and hospital admission was observed.Conclusion: Underlying prevalence of non-communicable diseases partly explained the heterogeneity in the AKI incidence at population level. Delay in admission after symptom onset could be associated with higher mortality among patients who developed AKI and warrants further research.

Insuficiencia renal y hemodiálisis en pacientes hospitalizados con COVID-19 durante la primera ola en Lima, Perú

“…La presencia de enfermedad renal crónica (ERC) como una comorbilidad en pacientes con COVID-19 aumenta el riesgo de hospitalización [10] , enfermedad severa [11] o morir en comparación con los que no tienen ERC [12,13] . Por su parte, la insuficiencia renal aguda (IRA) se presenta en alrededor del 20 % de pacientes con COVID-19 [14] , quienes pueden ser personas previamente sanas [15] o con comorbilidades renales y/o no renales [16] . La IRA en pacientes hospitalizados con COVID-19 también aumenta el riesgo de desenlaces clínicos negativos [17] .…”

Kidney health in the COVID-19 pandemic: An umbrella review of meta-analyses and systematic reviews

“…All these five reviews included hospitalized patients. The largest of which (Chan et al) included COVID-19 patients from 17 countries (Austria, Brazil, Canada, China, Denmark, France, Germany, India, Iran, Italy, Japan, Korea, Malaysia, Spain, Turkey, United Kingdom, and United States) and suggested that the incidence of AKI in general hospitalized COVID-19 patients was 20.4% (95% CI: 12.7–28.4%) ( 41 ).…”

“…One review rated as low risk of bias included three studies focused on pediatric COVID-19 patients and reported that the incidence of AKI was 16.11% ( 41 ).…”

“…Notably, substantial difference was observed in the reported AKI incidence across regions. Chan et al performed subgroup analyses and suggested that the incidences of AKI in Guangdong, Hong Kong, Hubei, Istanbul, Madrid, Michigan, New Delhi, New York, North Zealand, and Pennsylvania were 1.74, 3.72, 4.25, 29.17, 11.42, 44.79, 40.63, 33.07, 11.71, and 49.33%, respectively ( 41 ). In addition, Fu, E. L. included 49,048 hospitalized COVID-19 patients and reported that the incidence of AKI was 28.6% (95% CI: 19.8–39.5) in the USA and Europe ( n = 20 studies) and 5.5% (95% CI: 4.1–7.4) in Asia ( n = 62 studies) ( 30 ).…”

“…One review was considered eligible for update ( 41 ), thereby, 59 newly published studies were added. Fifty-eight studies only included hospitalized patients and 1 study included both hospitalized patients and non-hospitalized patients.…”