Risk Factors and Clinical Characteristics of Acute Kidney Injury in Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Acute kidney injury (AKI) is associated with a worse prognosis in coronavirus disease 2019 (COVID-19) patients. Identification of AKI, particularly in COVID-19 patients, is important for improving patients’ management. The study aims to assess risk factors and comorbidities of AKI in COVID-19 patients. We systematically searched PubMed and DOAJ databases for relevant studies involving confirmed COVID-19 patients with data on risk factors and comorbidities of AKI. The risk factors and comorbidities were compared between AKI and non-AKI patients. A total of 30 studies involving 22385 confirmed COVID-19 patients were included. Male (OR: 1.74 (1.47, 2.05)), diabetes (OR: 1.65 (1.54, 1.76)), hypertension (OR: 1.82 (1.12, 2.95)), ischemic cardiac disease (OR: 1.70 (1.48, 1.95)), heart failure (OR: 2.29 (2.01, 2.59)), chronic kidney disease (CKD) (OR: 3.24 (2.20, 4.79)), chronic obstructive pulmonary disease (COPD) (OR: 1.86 (1.35, 2.57)), peripheral vascular disease (OR: 2.34 (1.20, 4.56)), and history of nonsteroidal anti-inflammatory drugs (NSAID) (OR: 1.59 (1.29, 1.98)) were independent risk factors associated with COVID-19 patients with AKI. Patients with AKI presented with proteinuria (OR: 3.31 (2.59, 4.23)), hematuria (OR: 3.25 (2.59, 4.08)), and invasive mechanical ventilation (OR: 13.88 (8.23, 23.40)). For COVID-19 patients, male gender, diabetes, hypertension, ischemic cardiac disease, heart failure, CKD, COPD, peripheral vascular disease, and history of use of NSAIDs are associated with a higher risk of AKI.

Characteristics, Risk Factors, and Outcomes in Acute Kidney Injury Patients: A Retrospective Cross-Sectional Study, Palestine

“…The median age of patients diagnosed with AKI was 65 years. Furthermore, studies have shown that the risk of developing acute renal failure is three times higher in patients aged >65 years than in younger patients [ 28 ]. Increased age has been reported as a risk factor in AKI patients because of the physiological and structural changes in the kidneys with aging, which reduce nephron mass and glomerular filtration rate with an increased tendency towards cellular apoptosis [ 29 ].…”

“…In females, during the menstrual cycle, estrogen acts as a protective and therapeutic agent for the kidneys; however, this short-term effect decreases with age [ 29 ]. Furthermore, in a recent Systematic Review and Meta-Analysis, male gender was one of the many risk factors that placed COVID-19 patients at greater risk of developing AKI (OR: 1.74 (1.47, 2.05), P < 0.05) [ 33 ].…”

COVID-19 and cardiovascular disease in patients with chronic kidney disease

“…Apart from AKI, a substantial percentage of patients develops proteinuria during SARS-CoV-2 infection [ 113 ]. There are several potential reasons for this, some due to a possible direct pathogenetic effect of the virus in the kidney and others due to the systemic effects of the infection and critical illness.…”

Kidney Issues Associated with COVID-19 Disease

“…Advanced age, the presence of diabetes and obesity, cardiovascular disease, persistent CKD, acute respiratory distress syndrome and mechanical ventilation, nephrotoxic drugs, and hypotension with tissue hypoxia and vasopressor recruitment are several risk factors for the development of AKI in COVID 19 patients [37].…”