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

Yang, Luxi; Li, Jian; Wei, Wei; Yi, Cheng; Pu, Yajun; Zhang, Ling; Cui, Tianlei; Ma, Liang; Zhang, Juqian; Koyner, Jay L.; Zhao, Yuliang; Fu, Ping

doi:10.3389/fpubh.2022.963667

Cited by 10 publications

(11 citation statements)

References 87 publications

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“…Several studies have reported a significant association between CKD and adverse clinical outcomes, including higher rates of hospitalization, ICU admission, and mortality in COVID-19 patients with preexisting kidney disease. 43,44 CKD has been identified as an independent risk factor for COVID-19 severity, with decreased kidney function correlating with worse outcomes. 45 Moreover, CKD patients on maintenance dialysis have been reported to be particularly vulnerable, with an increased risk of complications and mortality compared to the general population.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence suggests that individuals with CKD and liver disease are at a higher risk of severe outcomes when infected with COVID‐19. Several studies have reported a significant association between CKD and adverse clinical outcomes, including higher rates of hospitalization, ICU admission, and mortality in COVID‐19 patients with preexisting kidney disease 43,44 . CKD has been identified as an independent risk factor for COVID‐19 severity, with decreased kidney function correlating with worse outcomes 45 .…”

Section: Discussionmentioning

confidence: 99%

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A network meta‐analysis of association between cardiometabolic risk factors and COVID‐19 outcome severity

Li,

Yang,

et al. 2023

Journal of Diabetes

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BackgroundCardiometabolic comorbidities have been associated with a higher risk of COVID‐19 severity and mortality, but more investigations are needed to determine which comorbidity is more detrimental.MethodsEmbase, Emcare, and MEDLINE were searched systematically for prospective and retrospective studies assessing the associations of cardiometabolic risk factors and COVID‐19 outcomes of hospitalization, severity, and mortality among COVID‐19‐diagnosed patients. Literature search was performed from first publication to May 19, 2021. Study quality was assessed by the Newcastle‐Ottawa Scale.ResultsFrom the literature search, 301 studies suggested that all included cardiometabolic risk factors were associated with a higher risk of COVID‐19 hospitalization, severity, and mortality, except that overweight was associated with a decreased risk of mortality (relative risk [RR] 0.88; 95% CI, 0.80–0.98). Patients with diabetes (RR 1.46; 95% CI, 1.45–1.47) were most likely to be hospitalized; patients with heart failure had the highest risk for severe COVID‐19 outcomes (RR 1.89; 95% CI, 1.71–2.09); while patients with stroke were most susceptible to overall mortality (RR 1.99; 95% CI, 1.90–2.08). In the network meta‐analysis, cerebrovascular disease had the highest impact (RR 1.69; 95% CI, 1.65–1.73) on COVID‐19 outcomes compared to other cardiometabolic risk factors. For different combinations of risk factors, cardiovascular disease and diabetes combined (RR 6.98; 95% CI, 5.28–9.22) was more detrimental than others.ConclusionsConsidering the high prevalence of cardiometabolic comorbidities and risk of all severe outcomes, patients with cardiometabolic comorbidities should be prioritized in vaccination and treatment development of COVID‐19.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A network meta‐analysis of association between cardiometabolic risk factors and COVID‐19 outcome severity

Li,

Yang,

et al. 2023

Journal of Diabetes

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“…Her daily urine volume was 1,500-2,000 mL. Laboratory data showed that her hemoglobin, platelet count, and serum creatinine were 98 g/L, 142×10 9 /L, and 238 µmol/L, respectively. She continued to receive hormonal therapy, antacid, blood pressure lowering agents, antiplatelet therapy, and treatment for anemia.…”

Section: Case Presentationmentioning

confidence: 99%

Thrombotic microangiopathy with kidney involvement in a patient with coronavirus disease 2019: A case report and literature review

Feng,

Nie,

Tan

et al. 2024

Preprint

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Background and aim: Millions of people worldwide have suffered from coronavirus disease 2019 (COVID-19). COVID-19 can lead to coagulopathy and thrombosis, presenting as pulmonary artery thromboembolism, deep vein thrombosis, and thrombotic microangiopathy (TMA), the latter being a rare finding in affected patients’ kidneys. Prior reports have rarely addressed the pathophysiology, clinical presentations, and therapeutic options in patients with COVID-19-associated TMA. Case presentation: We herein described a case of renal biopsy-proven TMA after COVID-19 in a 36-year-old woman. Initial examination revealed inflammation, acute kidney injury (AKI), anemia, and thrombocytopenia. She was diagnosed with hemolytic uremic syndrome, pulmonary infection, and COVID-19. After treatment, her condition stabilized but remained hemodialysis-dependent after discharge. One week later, she was re-hospitalized, and physical examination showed anemia and bilateral lower extremity edema. Abdominal ultrasound showed increased bilateral kidney echogenicity. Whole-exome sequencing detected an unknown variant of the C3 gene associated with hemolytic uremic syndrome susceptibility type 5/complement C3 deficiency. Kidney biopsy showed renal artery lesions, including small arteriole endothelial swelling, intimal thickening, mucinous degeneration, luminal occlusion, and small arterial wall necrosis. She received plasma exchange and steroids with significant renal function recovery. Conclusion: TMA likely contributed to AKI after COVID-19,thus supporting the notion that TMA plays an important role in the pathogenesis of COVID-19-related kidney injury. When diagnosing and treating COVID-19 patients with abnormal renal function, clinicians should incorporate kidney biopsy and genetic testing for the complement system, identify renal-limited and systemic TMA, and treat accordingly, which can improve patient outcomes.

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“…У цьому дослідженні кількість хворих серед чоловіків на 12 % перевищувала таку в жінок, а серед людей з ХХН -лише на 3 %. Відомо, що особи чоловічої статі мають вищі рівні рецептора АПФ-2, зокрема, такий феномен є у людей із серцевою недостатністю [10]. SARS-CoV-2 використовує саме рецептор АПФ-2 для входу в клітину і агресивніший варіант Delta, що містить багато мутацій в субодиниці S 1 , поліпшує його здатність зв'язуватися з АПФ-2 [11].…”

Section: обговоренняunclassified

Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2

Zavalna

2023

KIDNEYS

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Background. SARS-CoV-2 infection in patients with chronic kidney disease (CKD) and hypertension degree 1–2 worsens the state of the cardiovascular system and may contribute to cardiovascular events and adverse renal risks. The presence of CKD in combination with hypertension degree 1–2 and its medical correction with renin-angiotensin-aldosterone system (RAAS) inhibitors causes a significant impact on the health of patients infected with SARS-CoV-2. SARS-CoV-2 uses RAAS, namely the receptor for angiotensin-converting enzyme (ACE) 2, as a tool to enter the cell. To choose further approaches and treatment, this combination of three pathological conditions requires careful analysis and research. Objective: to study the functional state of the kidneys in patients with CKD and hypertension infected with SARS-CoV-2. Materials and methods. The article is a fragment of the BIRCOV (ARB, ACE inhibitors, DRi in COVID-19) trial, which was designed according to the POEM (Patient-Oriented Evidence that Matters). The BIRCOV (two-center, open-label, initiative-randomized, in three parallel arms) prospective study enrolled 120 patients with CKD and hypertension degree 1–2, it lasted for 1 year and was registered at ClinicalTrials.gov (NCT03336203). One hundred and twelve outpatients with degree 1–2 hypertension, 83 with combination with CKD, were selected. At the end of the study, 108 patients remained, their results are presented in the article with subsequent statistical processing. Division into groups occurred depending on the drugs received (ACE inhibitors, angiotensin receptor blockers (ARBs) or direct renin inhibitor (DRIs)). Endpoints were: estimated glomerular filtration rate (eGFR), average blood pressure, albuminuria level. In 24 patients, the urine albumin to creatinine ratio was analyzed at the beginning of SARS-CoV-2, then 2, 4, 12, 24 weeks after the onset of the disease. Mathematical processing and statistical evaluation of the research results was done in the medical statistics package. Results. All patients were divided into 3 groups depending on the drug: 35 (32 %) of them received ARBs, 42 (39 %) ACE inhibitors, 31 (29 %) DRIs. At the manifestation of SARS-CoV-2, a decrease in blood pressure was recorded during the first two weeks, with the subsequent return to baseline on week 12 in the group of people who received ACE inhibitors, the lowest indicator was in the DRI group. The use of ACE inhibitors (risk ratio (RR) 1.648, 95% confidence interval (CI) 0.772–3.519, number needed to treat (NNT) 7.0) and ARBs (RR 13.023, 95% CI 1.815–93.426, NNT 19) in the treatment of hypertension significantly increased the risk of withdrawal compared to DRIs. Patients with CKD had similar dynamics of blood pressure during 24 weeks of observation. In CKD, higher mean blood pressure values were obtained compared to other participants of the BIRCOV trial. A simultaneous decrease in eGFR and systolic blood pressure was documented, it was most pronounced in patients with CKD. The lowest results were in people who took ACE inhibitors for 0–24 weeks: the correlation coefficient was 0.815. A decrease in eGFR correlated with the degree of CKD. There was a decrease in eGFR of less than 60 ml/min during the first 4 weeks from the onset of SARS-CoV-2 in 28 people who took ACE inhibitors versus 22 who used ARBs or DRIs: absolute risk was 0.667 (RR 2.00, 95% CI 1.337–2.92, NNT 3.0). The relative risk of eGFR reduction was 16.6 (95% CI 5.263–52.360, NNT 1.774) for people receiving ACE inhibitors versus all patients with CKD, 2.049 for ARBs (95% CI 0.361–11.22, NNT 1.774) and 1.064 for DRIs versus the entire sample of people with CKD (95% CI 0.116–9.797, NNT 431.6). After 12 weeks of follow-up, eGFR almost returned to baseline in CKD stage 2–3a. An increase in the urine albumin to creatinine ratio (which did not reach the baseline within 24 weeks from the onset of the disease) was recorded in CKD patients with stable renal function during the first 12 weeks from the onset of SARS-CoV-2 (the mean values of eGFR were not statistically different within 2–24 weeks). Males had a higher risk of CKD progression to end-stage renal disease. In people with SARS-CoV-2, on the second week from the onset of the disease, a decrease in eGFR was observed with a reciprocal increase in the level of blood uric acid, which differed significantly from the baseline values. The use of dexamethasone was accompanied by a decrease in eGFR (Р ≤ 0.05) and the preservation of these disorders in people with CKD stage 3b-4 up to 24 weeks of observation (RR 0.686, 95% CI 0.264–1.780, NNT 7.636). Conclusions. The course of SARS-CoV-2 in people with hypertension degree 1–2 was characterized by the development of significant hypotension among those taking ACE inhibitors, and in patients with CKD and hypertension taking ACE inhibitors — by a decrease in GFR, hypotension, an increase in albuminuria and in the urine albumin to creatinine ratio, which was transient in most cases. Albuminuria increased less significantly in patients taking ARBs and was practically unchanged when using DRIs. Patients with CKD stage 4 and hypertension degree 2 had the greatest risks of an unfavorable prognosis. The authors hypothesized about the mechanism of SARS-CoV-2 effect when using ACE inhibitors that was similar to that of ARBs (ARB effect), i.e., in people who took ACE inhibitors, the effect of reducing blood pressure was comparable to that of the dual RAAS blockade with ACE inhibitors and ARBs.

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

Cited by 10 publications

References 87 publications

A network meta‐analysis of association between cardiometabolic risk factors and COVID‐19 outcome severity

A network meta‐analysis of association between cardiometabolic risk factors and COVID‐19 outcome severity

Thrombotic microangiopathy with kidney involvement in a patient with coronavirus disease 2019: A case report and literature review

Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2

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