Incidence and Outcomes of Acute Kidney Injury in COVID-19: A Systematic Review

Abstract

<b><i>Background and Objectives:</i></b> The recent worldwide pandemic of COVID-19 has been a serious, multidimensional problem that has left a detrimental worldwide impact on individuals of all ages and several organ systems. The typical manifestation of kidney involvement is acute kidney injury (AKI); however, there is a lack of consensus data regarding AKI epidemiology in COVID-19. This systematic literature review aims to bridge this knowledge gap. <b><i>Design, Setting, Participants, and Measurements:</i></b> MEDLINE and Cochrane library were systematically searched for the literature related to AKI in COVID-19 patients of all ages. MedRxIV was searched for relevant unpublished manuscripts. Two reviewers independently assessed the literature on the incidence of AKI and mortality, extracting the need for kidney replacement therapy (KRT). <b><i>Results:</i></b> Sixty studies (<i>n</i> = 43,871 patients) were included in this review. The pooled incidence of AKI among COVID-19 patients was 19.45% (95% confidence intervals [95% CI]: 14.63–24.77%), while the pooled incidence of AKI COVID-19 patients requiring KRT was 39.04% (16.38–64.57%). The pooled proportion of COVID+ patients was significantly lower at 8.83% (5.64% to 12/66%). The overall mortality of COVID-19 patients was calculated to be 17.71% (95% CI: 11.49–24.93%), while the mortality among patients with AKI was higher at 54.24% (95% CI: 44.70–63.63%). <b><i>Conclusion:</i></b> This comprehensive systematic review summarizes the available literature pertaining to AKI epidemiology in COVID-19 patients and highlights the incidence, associated mortality, and the need for KRT in this susceptible population.

Urinalysis, but Not Blood Biochemistry, Detects the Early Renal Impairment in Patients with COVID-19

“…In contrast to those findings, however, a single-centered observational study by Yang X (2020) found that 29% of patients with severe SARS-CoV-2 pneumonia developed acute kidney injury (AKI) [19]. Similar results were obtained in the retrospective cohort studies of J.S Bell (2021) and Li Z (2020) and described in the systematic reviews of SA Silver (2021) and R Raina [20][21][22][23]. According to those studies, AKI occurred in over a quarter of patients hospitalized with COVID-19 [20][21][22][23].…”

Impact of COVID‐19 on the worsening crisis of chronic kidney disease: the imperative to fund early detection is now

“…Despite the early and aggressive response to the pandemic by the state, territory and federal governments of Australia, more than 2000 deaths have been reported and over 220 000 cases confirmed 3 . The clinical spectrum of SARS‐CoV‐2 infection is varied and ranges from asymptomatic infection through to severe viral pneumonia with diffuse alveolar haemorrhage, respiratory failure and death 4 . The virus mediates disease through binding to the angiotensin‐converting enzyme 2 (ACE2) receptor, after which the virus is internalised and replicates 5 .…”

“…Acute kidney injury (AKI) complicates COVID‐19 infection in approximately 20% of cases, with over one‐third (39%) of these requiring kidney replacement therapy 4 . AKI in the setting of COVID‐19 is associated with poor outcomes and high mortality rates 6 .…”

“…5 Acute kidney injury (AKI) complicates COVID-19 infection in approximately 20% of cases, with over onethird (39%) of these requiring kidney replacement therapy. 4 AKI in the setting of COVID-19 is associated with poor outcomes and high mortality rates. 6 One retrospective study of nearly 10 000 patients showed that inhospital death increased from 7% in those without AKI to 46% in those with AKI not receiving dialysis and to 79% in those with AKI requiring dialysis.…”

“…3 The clinical spectrum of SARS‐CoV‐2 infection is varied and ranges from asymptomatic infection through to severe viral pneumonia with diffuse alveolar haemorrhage, respiratory failure and death. 4 The virus mediates disease through binding to the angiotensin‐converting enzyme 2 (ACE2) receptor, after which the virus is internalised and replicates. 5 While ACE2 is present in the lung, the receptor is also present in the kidney, and there is clear evidence that SARS‐CoV‐2 infection commonly leads to both acute kidney disease and CKD through both direct infection and systemic effects.…”