The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis
Samuel A. Silver, William Beaubien–Souligny, Prakesh S. Shah, Shai Har-El, Daniel Blum, Teruko Kishibe, Alejandro Meraz-Muñoz, Ron Wald, Ziv Harel
Abstract
RATIONALE & OBJECTIVE: Coronavirus disease 2019 (COVID-19) may be associated with high rates of acute kidney injury (AKI) and kidney replacement therapy (KRT), potentially overwhelming health care resources. Our objective was to determine the pooled prevalence of AKI and KRT among hospitalized patients with COVID-19. STUDY DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, the Cochrane Library, and a registry of preprinted studies, published up to October 14, 2020. STUDY SELECTION: Eligible studies reported the prevalence of AKI in hospitalized patients with COVID-19 according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. DATA EXTRACTION & SYNTHESIS: We extracted data on patient characteristics, the proportion of patients developing AKI and commencing KRT, important clinical outcomes (discharge from hospital, ongoing hospitalization, and death), and risk of bias. OUTCOMES & MEASURES: We calculated the pooled prevalence of AKI and receipt of KRT along with 95% CIs using a random-effects model. We performed subgroup analysis based on admission to an intensive care unit (ICU). RESULTS: = 88%) commenced KRT. LIMITATIONS: There was significant heterogeneity among the included studies, which remained unaccounted for in subgroup analysis. CONCLUSIONS: AKI complicated the course of nearly 1 in 3 patients hospitalized with COVID-19. The risk for AKI was higher in critically ill patients, with a substantial number receiving KRT at rates higher than the general ICU population. Because COVID-19 will be a public health threat for the foreseeable future, these estimates should help guide KRT resource planning.