AKI in Patients with Coronavirus Disease 2019: Review and Meta-Analysis

Kidney Week 2020

As the coronavirus disease 2019 (COVID-19) spread around the world, reports of renal involvement varied across regions. Kam wa Chan, MD, and colleagues at the University of Hong Kong and the London School of Hygiene and Tropical Medicine conducted a review and meta-analysis to assess the global prevalence of renal manifestations among patients with COVID-19 and identify the risk factors associated with acute kidney injury (AKI) related to COVID-19.

The researchers reported results of the analysis during a virtual poster session at ASN Kidney Week 2020. The poster was titled Renal Involvement in Coronavirus Disease 2019 (RECORD): A Systematic Review and Meta-Analysis.

The researchers systematically searched six databases for peer-reviewed reports and seven data portals for grey literature for all trials, cohorts, case-control studies, and case-series reporting the prevalence of renal manifestations of COVID-19, including AKI, renal replacement therapy (RRT), proteinuria and hematuria, and their associated risk factors. Papers were screened by a minimum of two independent researchers.

Study quality was determined using National Institutes of Health assessment tools. Location, institutions, and time periods were matched to avoid duplication of patient data, and if studies overlapped, the meta-analysis only included the largest data source. The pooled prevalence of renal manifestations was obtained from studies that consecutively recruited patients from the general population and those with a clear definition of outcome. The review was prospectively registered at PROSPERO (CRD42020184621).

The search yielded 36 studies from eight countries and more than 50 cities, representing a total of 14,712 patients. Thirty-four of the studies were cohort studies and two were case-control studies. Of the 36 studies, 24 included COVID-19 patients from the general population, seven included severe/critical patients, and five reported results of patients with a history of RRT.

Overall, AKI occurred in 14.3% of COVID-19 cases, with the highest prevalence in New York City. Of hospitalized COVID-19 patients, 4.7% underwent RRT. Proteinuria and hematuria were observed in 42.5% and 26.7% of all COVID-19 cases, respectively.

The odds of mortality among COVID-19 patients with AKI were 15 times higher than among non-AKI COVID-19 patients (pooled odds ratio [OR], 16.85; 95% confidence interval [CI], 10.06-28.23; results from two cities, six studies, 9297 patients). The odds of mortality were higher in the province of Hubei, China. Increased risk of mortality was not seen in kidney transplant recipients (pooled OR, 0.95; 95% CI, 0.12-7.22; results from two studies, 30 patients).

There were associations between higher C-reactive protein, leukocyte count, serum lactate dehydrogenase, and creatinine levels on admission and AKI.

“AKI was prevalent among COVID-19 patients and significantly associated with mortality. The odds of mortality among AKI patients varied significantly between cities, which could be associated with differences in healthcare infrastructure and delayed hospitalization and treatment initiation,” the researchers said.

Source: Chan Kw, Yu KY, Lee PW, Tang SC. Renal involvement in coronavirus disease 2019 (RECORD): A systematic review and meta-analysis. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2020 (PO0661), October 22, 2020.