Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis

Abstract

ObjectiveTo analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19.DesignMeta-analysis.Data sourcesPubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020.Study selectionStudies examining the following demographics and outcomes were included: patients’ age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection.ResultsA total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92–4.25) and an OR of 6.07, 95% CI (2.53–14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83–15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13–13.36).ConclusionAKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.

The systemic review of subgroup analysis on the incidence of acute kidney injury(AKI) in patients with COVID-19

“…We found that the incidence of AKI in COVID-19 patients was 10%. A similar AKI incidence in COVID-19 patients (10.8%) was also reported in other studies [34]. The diversity of patients included in our systemic review caused heterogeneity.…”

“…SARS-CoV-2 enters cells via the angiotensin-converting enzyme 2 (ACE2) receptor and is highly homologous to SARS-CoV [33]. High ACE2 expression in proximal tubular epithelial cells may be a potential target for kidney injury [34]. Renal abnormalities, such as proteinuria, haematuria, and AKI, occur in patients with COVID-19 [35].…”

Manifestaciones extratorácicas de la COVID-19 en adultos y presentación de la enfermedad en niños

“…Se han descrito alteraciones renales frecuentes en COVID-19, manifestándose principalmente con insuficiencia renal, con una etiología habitualmente multifactorial que incluye la propia afectación por el virus, el cuadro inflamatorio sistémico y las alteraciones de la coagulación y en algunos casos secundarias a rabdomiólisis 3 , 6 , 49 , y que se asocian con mayor gravedad y mortalidad de la infección 50 .…”

SARS-CoV-2 and Viral Sepsis: Immune Dysfunction and Implications in Kidney Failure

“…Recent data proposed several demographic parameters—such as male sex, older age, diabetes mellitus, hypertension, cardiovascular disease, congestive heart failure, high body mass index, chronic kidney disease (CKD), genetic risk factors, immunosuppression, and smoking history—that could induce or increase the incidence and progression of AKI [ 10 , 40 , 41 , 42 ]. Lin et al performed the first systematic analysis of the COVID-19 risk factors on 79 research articles, and showed that patients with advanced age were more vulnerable to the development of AKI, probably due to weakened immune system function and the physiological aging of organs [ 43 ]. Moreover, Shastri et al observed that male patients had a lower capacity in SARS-CoV-2 clearance after infection compared to female patients, underlying the gender disparity in the disease’s severity [ 44 ].…”

“…Moreover, Shastri et al observed that male patients had a lower capacity in SARS-CoV-2 clearance after infection compared to female patients, underlying the gender disparity in the disease’s severity [ 44 ]. Moreover, the impact of high-risk behaviors like smoking and alcohol consumption could make male patients more susceptible to AKI in COVID-19 disease [ 43 ]. Moreover, certain genetic traits might increase susceptibility to the development of AKI in the course of SARS-CoV-2 infection [ 10 ].…”