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Renal complications in COVID-19: a systematic review and meta-analysis
Setor K Kunutsor1,2, Jari A Laukkanen3,4,5
1National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Insights
COVID-19 frequently causes kidney complications, including electrolyte disturbances and acute kidney injury (AKI). Early monitoring of these renal issues in hospitalized patients may improve outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) is known to affect multiple organ systems.
- Extrapulmonary manifestations of COVID-19 are increasingly recognized, but renal complications require further definition.
Purpose of the Study:
- To systematically evaluate the renal complications associated with COVID-19.
- To determine the incidence of various renal complications in COVID-19 patients through meta-analysis.
Main Methods:
- A systematic meta-analysis was conducted on observational cohort studies published between 2019 and June 2020.
- Studies were identified from MEDLINE, Embase, and the Cochrane Library.
- Incidence rates and confidence intervals were pooled using random-effects models, with study quality assessed using the Newcastle-Ottawa Scale.
Main Results:
- The meta-analysis included 22 studies with 17,391 COVID-19 patients.
- Prevalence of pre-existing chronic kidney disease (CKD) was 5.2% and end-stage kidney disease was 2.3%.
- Pooled incidence over 2-28 days included electrolyte disturbance (12.5%), acute kidney injury (AKI) (11.0%), and renal replacement therapy (RRT) (6.8%). AKI incidence was higher in US populations and those with pre-existing CKD.
Conclusions:
- Hospitalized COVID-19 patients frequently experience renal complications such as electrolyte disturbances, AKI, and RRT.
- Proactive monitoring and management of these renal complications are crucial for predicting patient outcomes.
- COVID-19's impact extends beyond the respiratory system, highlighting the importance of understanding its renal manifestations.
Purpose:
Emerging data suggest that coronavirus disease 2019 (COVID-19) has extrapulmonary manifestations but its renal manifestations are not clearly defined. We aimed to evaluate renal complications of COVID-19 and their incidence using a systematic meta-analysis.
Design:
Observational studies reporting renal complications in COVID-19 patients were sought from MEDLINE, Embase and the Cochrane Library from 2019 to June 2020. The nine-star Newcastle-Ottawa Scale was used to evaluate methodological quality. Incidence with 95% confidence intervals (CIs) were pooled using random-effects models.
Results:
We included 22 observational cohort studies comprising of 17,391 COVID-19 patients. Quality scores of studies ranged from 4 to 6. The pooled prevalence of pre-existing chronic kidney disease (CKD) and end-stage kidney disease was 5.2% (2.8-8.1) and 2.3% (1.8-2.8), respectively. The pooled incidence over follow-up of 2-28 days was 12.5% (10.1-15.0) for electrolyte disturbance (e.g. hyperkalaemia), 11.0% (7.4-15.1) for acute kidney injury (AKI) and 6.8% (1.0-17.0) for renal replacement therapy (RRT). In subgroup analyses, there was a higher incidence of AKI in US populations and groups with higher prevalence of pre-existing CKD.
Conclusions:
Frequent renal complications reported among hospitalized COVID-19 patients are electrolyte disturbance, AKI and RRT. Aggressive monitoring and management of these renal complications may help in the prediction of favourable outcomes. Systematic review registration: PROSPERO 2020: CRD42020186873 KEY MESSAGES COVID-19 affects multiple organs apart from the respiratory system; however, its renal manifestations are not clearly defined. In this systematic meta-analysis of 22 observational cohort studies, the prevalence of pre-existing chronic kidney disease (CKD) in COVID-19 patients was 5.2%. The most frequent renal complication was electrolyte disturbance (particularly hyperkalaemia) with an incidence of 12.5% followed by acute kidney injury (AKI) with an incidence of 11.0%; US populations and groups with higher prevalence of CKD had higher incidence of AKI.
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