Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

Abstract

Introduction: There are limited data on the association of kidney dysfunction with prognosis in coronavirus disease 2019 (COVID-19), and the extent to which acute kidney injury (AKI) predisposes patients to severe illness and inferior outcomes is unclear. We aim to assess the incidence of AKI among patients with COVID-19 and examine their associations with patient outcomes as reported in the available literature thus far. Methods: We systematically searched MEDLINE, EMBASE, SCOPUS, and MedRxiv databases for full-text articles available in English published from December 1, 2019 to May 24, 2020. Clinical information was extracted and examined from 20 cohorts that met inclusion criteria, covering 13,137 mostly hospitalized patients confirmed to have COVID-19. Two authors independently extracted study characteristics, results, outcomes, study-level risk of bias, and strength of evidence across studies. Neither reviewer was blind to journal titles, study authors, or institutions. Results: Median age was 56 years, with 55% male patients. Approximately 43% of patients had severe COVID-19 infection, and approximately 11% died. Prevalence of AKI was 17%; 77% of patients with AKI experienced severe COVID-19 infection, and 52% died. AKI was associated with increased odds of death among COVID-19 patients (pooled odds ratio, 15.27; 95% CI 4.82-48.36), although there was considerable heterogeneity across studies and among different regions in the world. Approximately 5% of all patients required use of renal replacement therapy (RRT). Conclusions: Kidney dysfunction is common among patients with COVID-19, and patients who develop AKI have inferior outcomes. Additional research into management and potential mechanisms of this association is needed.

Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury

“…While causality cannot be inferred from an observational study, the uremic milieu caused by AKI can impact immune function,27 inflammation,28 and coagulation 29. Consistent with our findings, recent publications have reported on the association of AKI with inhospital death among those hospitalized with COVID-1911 . Early reports from Wuhan, China, found that even after adjusting for age, sex, disease severity, and comorbid conditions, the risk of death was increased with AKI (HR ranging 1.9-4.7 for increasing stages of AKI).…”

“…where large numbers of patients did not have completed outcomes, 7,11,37 over 99% of our patients had completed outcomes, with fewer than 1% still hospitalized. We employed time-toevent analyses using AKI exposure as a time-varying covariate, and thus avoiding immortal time bias.…”

“…[7][8][9][10] As recovery from COVID-19, especially when severe, often takes weeks in the hospital, previously published studies may result in a skewed view of endpoints, potentially biasing toward adverse outcomes. [11][12][13] Additionally, prior publications have not addressed varied timelines of AKI development during hospitalization or the varied duration of follow-up.…”

Chronic Kidney Diseases and Acute Kidney Injury in Patients With COVID-19: Evidence From a Meta-Analysis

“…Although far from detailed, the importance of AKI has been more profiled by several reports in COVID-19 patients (6, 7). More recently, several meta-analyses have proved the important prognostic values of AKI in severe COVID-19 patients (74)(75)(76)(77). As a vital complication, the presence of AKI was associated with more adverse prognosis in the disease course.…”

Comparison of renal replacement therapy and renal recovery before and during the COVID-19 pandemic- A single centre observational study

“…Comparison of renal replacement therapy and renal recovery before and during the COVID-19 pandemic-A single centre observational study Introduction Provision of renal replacement therapy (RRT) for patients with COVID-19 was challenging for both logistical and disease-related factors [1]. A signi cant proportion of COVID-19 patients developed acute kidney injury (AKI), many of whom require RRT [2]. In our institution, as with many others, shortages of continuous venovenous hemodia ltration (CVVHDF) machines and replacement uids necessitated reduced intensity of hemo ltration (exchange rates) to facilitate the greatly increased demand for RRT capacity.…”