Systematic review and subgroup analysis of the incidence of acute kidney injury (AKI) in patients with COVID-19

Xu, Zhenjian; Tang, Ying; Huang, Qiuyan; Fu, Sha; Li, Xiaomei; Lin, Baojuan; Xu, Anping; Chen, Junzhe

doi:10.1186/s12882-021-02244-x

Cited by 41 publications

(43 citation statements)

References 57 publications

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“…The relative risk of serum creatinine elevation (RR 0.66; 95%CI 0.55–0.80; p < 0.001) was also lower in the remdesivir-treated group than the placebo. A systematic review and subgroup analysis by Xu et al [ 35 ] revealed that remdesivir did not increase the incidence of acute kidney injury in patients with COVID-19. Three RCTs [ 9 – 11 ] independently reported that a similar proportion of adverse effects occurred in the remdesivir and placebo groups.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis

2021

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Purpose This review was aimed to synthesise the best available evidence on the effectiveness and safety of remdesivir in the treatment of moderate to severe COVID-19. Method Randomised controlled trials (RCTs) and observational studies reporting the effectiveness and safety of remdesivir were searched via databases and other sources from December 2019 to December 2020. Two independent reviewers performed literature screening, data extraction and assessment of risk bias. Seven studies involving 3686 patients were included. Results Treatment with remdesivir was associated with an increase in clinical recovery rate by 21% (RR 1.21; 95% CI 1.08–1.35) on day 7 and 29% (RR 1.29; 95% CI 1.22–1.37) on day 14. The likelihoods of requiring high-flow supplemental oxygen and invasive mechanical ventilation in the remdesivir group were lower than in the placebo group by 27% (RR 0.73; 95% CI 0.54–0.99) and 47% (RR 0.53; 95% CI 0.39–0.72), respectively. Remdesivir-treated patients showed a 39% (RR 0.61; 95% CI 0.46–0.79) reduction in the risk of mortality on day 14 compared to the control group; however, there was no significant difference on day 28. Serious adverse effects (SAEs) were significantly less common in patients treated with remdesivir, with an absolute risk difference of 6% (RD −0.06; 95% CI −0.09 to −0.03). Conclusion Despite conditional recommendation against its use, remdesivir could still be effective in early clinical improvement; reduction of early mortality and avoiding high-flow supplemental oxygen and invasive mechanical ventilation among hospitalised COVID-19 patients. Remdesivir was also well tolerated without significant SAEs compared to placebo, yet available evidence from clinical studies support the need to conduct close monitoring. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01671-0.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis

2021

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“…Its incidence is high (estimated to be 2–20% in hospitalized patients) and its mortality remains around 20% [ 251 ]. Of recent interest, AKI develops in 10% of hospitalized Covid-19 patients [ 254 ]. Beyond the acute phase, AKI was found to be associated with an 8.8-fold risk for CKD [ 255 ].…”

Section: Mrtf In Kidney Diseasesmentioning

confidence: 99%

MRTF: Basic Biology and Role in Kidney Disease

Miranda

Lichner

Szászi

et al. 2021

IJMS

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A lesser known but crucially important downstream effect of Rho family GTPases is the regulation of gene expression. This major role is mediated via the cytoskeleton, the organization of which dictates the nucleocytoplasmic shuttling of a set of transcription factors. Central among these is myocardin-related transcription factor (MRTF), which upon actin polymerization translocates to the nucleus and binds to its cognate partner, serum response factor (SRF). The MRTF/SRF complex then drives a large cohort of genes involved in cytoskeleton remodeling, contractility, extracellular matrix organization and many other processes. Accordingly, MRTF, activated by a variety of mechanical and chemical stimuli, affects a plethora of functions with physiological and pathological relevance. These include cell motility, development, metabolism and thus metastasis formation, inflammatory responses and—predominantly-organ fibrosis. The aim of this review is twofold: to provide an up-to-date summary about the basic biology and regulation of this versatile transcriptional coactivator; and to highlight its principal involvement in the pathobiology of kidney disease. Acting through both direct transcriptional and epigenetic mechanisms, MRTF plays a key (yet not fully appreciated) role in the induction of a profibrotic epithelial phenotype (PEP) as well as in fibroblast-myofibroblast transition, prime pathomechanisms in chronic kidney disease and renal fibrosis.

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“…Chan et al confirmed an AKI rate in COVID-19 patients of 7.58% (95% CI 3.30–13.54%) [ 12 ]. The recent meta-analysis of Xu et al showed that the frequency of AKI in COVID-19 patients lies somewhere around 10%, and that kidney damage is more frequent in older patients and patients suffering with a more acute form of the disease [ 13 ]. Putting all these factors together, these data led to the hypothesis that SARS-CoV-2 targets the kidney.…”

Section: Recent Findingsmentioning

confidence: 99%

“…It should also be noted that the AKI frequency in COVID-19 patients is of great concern. We and several other groups have observed an increased rate of AKI in patients with CKD history and in those suffering from other severe diseases [ 13 ]. Yet, none of this indicates a direct effect of COVID-19 on the kidneys.…”

Section: Pro and Contramentioning

confidence: 99%

Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? A comprehensive assessment of viral RNA and AKI rate in patients with COVID-19

Enikeev

Taratkin

Efetov

et al. 2021

Current Opinion in Urology

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Purpose of review To investigate the possible effects of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) on kidney function and assess the rate of viral ribonucleic acid (RNA) shedding/detection in urine. Recent findings Most of the research on the topic suggests that for the moment our ability to estimate whether SARS-CoV-2 is a direct causative agent in acute kidney injury (AKI) or whether it has a cytokine storm effect is limited. During our prospective assessment of 333 patients with COronaVIrus Disease 2019 (COVID-19) it was found that frequency of AKI of 9.6% (32 cases). Despite previous data suggestive of the ability to detect SARS-CoV-2 in urine, we were unable to identify any traces of messenger ribonucleic acid (mRNA) in our group. Both COVID-19 severity (odds ratio, OR = 23.09, confidence interval, CI 7.89–67.57, P < 0.001) and chronic kidney disease (CKD) history (OR = 7.17, CI 2.09–24.47, P = 0.002) were associated with the AKI rate. Summary AKI is a relatively frequent condition for patients with COVID-19 and is normally correlated with the severity of the disease and the patient's history of CKD. The available data fail to address whether SARS-CoV-2 mRNA is present in urine, whereas our prospective trial data suggest that mRNA is undetectable in urine irrespective of the severity of the disease.

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Systematic review and subgroup analysis of the incidence of acute kidney injury (AKI) in patients with COVID-19

Cited by 41 publications

References 57 publications

Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis

Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis

MRTF: Basic Biology and Role in Kidney Disease

Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? A comprehensive assessment of viral RNA and AKI rate in patients with COVID-19

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