Acute kidney injury outcomes in covid-19 patients: systematic review and meta-analysis

Abstract

Background: Acute kidney injury (AKI) is a frequent complication of coronavirus-19 disease (COVID-19). Therefore, we decided to perform a systematic review and meta-analysis with data from the literature to relate the development of COVID-19 associated-AKI with comorbidities, medications, and the impact of mechanical ventilation. Methods: We performed a systematic review using the Newcastle-Ottawa scale and a meta-analysis using the R program. Relevant studies were searched in the PubMed, Medline, and SciELO electronic databases. Search filters were used to include reports after 2020 and cohort studies. Results: In total, 1166 articles were identified and 55 English-written articles were included based on the risk of bias. Of all COVID-19-hospitalized patients presenting with AKI (n = 18029) classified as Kidney Disease Improving Global Outcomes stage 1 to 3, approximately 18% required mechanical ventilation and 39.2 % died. Around 11.3% of the patients required kidney replacement therapy (KRT) and of these, 1093 died and 321 required continuous KRT. Death is more frequent in individuals with AKI [OR 6.03, 95%CI: 5.73-6.74; p<0.01]. Finally, mechanical ventilation is an aggravating factor in the clinical conditions studied [OR 11.01, 95%CI: 10.29-11.77; p<0.01]. Conclusion: Current literature indicates AKI as an important complication in COVID-19. In this context, we observed that comorbidities, such as chronic kidney disease and heart failure, were more related to the development of AKI. In addition, mechanical ventilation was seen as an aggravating factor in this scenario.

Outcomes, Risk Factors, and Incidence of Acute Kidney Injury in Hospitalized COVID-19 Patients

“…In three different studies carried out by Cheng, Li, and Ng on AKI in COVID-19 patients, the incidence of AKI was reported to be between 5.4% and 39.9%, and mortality in these patients was 30% to 40% (22)(23)(24). Moreover, Silva et al, in a systematic review, reported an incidence rate of 31% for AKI, and the mortality of 39.2% in these patients (25). Although the AKI incidence rate in our study was compatible with their findings, the mortality rate was higher.…”

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

“…Additionally, we did not see any significant difference in AKI requiring dialysis. This shows that AKI in IBD is usually self-limited and likely due to volume depletion, as seen in the general population [ 27 ]. Therefore, timely volume resuscitation is vital in preserving renal function, especially in IBD patients.…”

Global Perspectives in AKI: Peru

“…11 These results differ from those of some systematic reviews that show a lower incidence and higher mortality particularly in ICU patients worldwide. 12,13 This difference could probably be related to the delayed medical care caused by the saturation of Peruvian hospitals during the first and second waves of the pandemic and the prioritization of ICU admission of patients with better prognosis. 14 Similar to other countries in Latin America, in Peru, hospitalized patients with AKI in need of dialysis most frequently receive hemodialysis (HD) given the little availability of continuous renal replacement therapy (CRRT), prolonged intermittent renal replacement therapy, or peritoneal dialysis (PD) even for critically ill patients.…”

“… 11 These results differ from those of some systematic reviews that show a lower incidence and higher mortality particularly in ICU patients worldwide. 12 , 13 This difference could probably be related to the delayed medical care caused by the saturation of Peruvian hospitals during the first and second waves of the pandemic and the prioritization of ICU admission of patients with better prognosis. 14 …”