High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis

Abstract

AimsHospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI.MethodsWe systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model.ResultsFrom 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%–100%).ConclusionThe present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients’ outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.

A risk score based on procalcitonin for predicting acute kidney injury in COVID‐19 patients

“…[7][8][9][10] Acute kidney injury (AKI), whose incidence ranged from 0.5% to 40% in COVID-19 patients, could increase the risk of poor outcome and length of hospital stay. 6,[11][12][13][14] Consequently, identifying COVID-19 patients with high risk of developing AKI during hospitalization and therefore making suitable treatment strategies are essential to improve prognosis of patients.…”

Sodium-glucose co-transporter 2 inhibitors in COVID-19: meeting at the crossroads between heart, diabetes and infectious diseases

“…Endothelial dysfunction, excessive inflammation, ischemic injury and hypercoagulability are considered to be essential mechanisms in the development of acute kidney injury (AKI) in COVID-19. AKI is associated with a 13-fold greater risk of death among SARS-CoV-2 infected individuals [14]. Of note, Menon et al [15] recently showed that renal damage in diabetes and COVID-19 might share common backgrounds, by demonstrating that the diabetic kidney disease angiotensin converting enzyme 2 (ACE2)positive proximal tubular epithelial cell module overlaps with the expression patterns observed in SARS-CoV-2 infected cells.…”

Endothelin antagonism and sodium glucose Co-transporter 2 inhibition. A potential combination therapeutic strategy for COVID-19

“…UK Intensive Care audit data showed renal replacement therapy was delivered in 31% of patients on ventilators, and 4% not on ventilators( 61 ). A recent meta-analysis of 15536 hospitalised patients with COVID-19 determined an overall incidence of AKI of 12.3%, 77% of whom were critically ill. Mortality was 67% in patients with AKI, 13 times higher compared with patients without AKI( 62 ) In comparison, data from H1N1 influenza epidemic, showed that out of those who received intensive care, nearly 18% of patients (without pre-existing CKD) developed AKI and up to two thirds of patients who had a complicated course of H1N1 infection had AKI( 63 ). In contrast, data from the SARS pandemic suggests a lower rate of AKI at 7% of patients hospitalised with the infection, although mortality rate was as high as 90% in patients with renal failure( 64 ).…”