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COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

Fabrizio Fabrizi1, Carlo M Alfieri1,2, Roberta Cerutti1

  • 1Division of Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy.

Pathogens (Basel, Switzerland)
|December 18, 2020
PubMed

Insights

Acute kidney injury (AKI) is a frequent complication in hospitalized COVID-19 patients, affecting 15.4% of cases. Older age and hypertension increase AKI risk, which is significantly higher in deceased patients.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is a global pandemic with significant morbidity and mortality.
  • Preliminary evidence indicates acute kidney injury (AKI) is an uncommon but serious complication in COVID-19 patients.
  • AKI in COVID-19 is associated with poorer patient outcomes, necessitating further investigation.

Purpose of the Study:

  • To systematically review and meta-analyze clinical studies on the frequency of AKI in hospitalized COVID-19 patients.
  • To evaluate the incidence of AKI and the requirement for renal replacement therapy (RRT) in this population.
  • To assess the relationship between AKI and mortality risk in COVID-19 patients.

Main Methods:

  • A systematic literature review and meta-analysis of clinical studies were performed.
  • Data from 39 studies encompassing 25,566 unique COVID-19 patients were analyzed.
  • The DerSimonian and Laird random-effects model was used, incorporating heterogeneity and stratified analyses.

Main Results:

  • The pooled incidence of AKI across studies was 15.4% (95% CI, 10.7%-20.1%), with significant heterogeneity observed.
  • The overall frequency of RRT in COVID-19 patients was 4.3% (95% CI, 3.1%-5.5%).
  • AKI incidence was higher in severe COVID-19 cases (53%) and strongly associated with mortality (OR 15.4). Age and arterial hypertension were identified as risk factors for AKI.

Conclusions:

  • Acute kidney injury (AKI) is a common and significant complication in hospitalized patients with COVID-19.
  • The findings highlight the increased risk of AKI and its association with mortality in this patient group.
  • Further research is warranted to elucidate the mechanisms of kidney injury in COVID-19 and to develop targeted interventions.
Abstract

Keywords:
COVID-19SARS-CoV-2acute kidney injurymortalityrenal replacement therapysevere disease

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