Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis

  1. Tanawin Nopsopon
  2. Jathurong Kittrakulrat
  3. Kullaya Takkavatakarn
  4. Thanee Eiamsitrakoon
  5. Talerngsak Kanjanabuch
  6. Krit Pongpirul

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Abstract

The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT.

Methodology/Principal findings

We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09–22.32) which was higher than the global average at 4.98%.

Conclusions

This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.

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  1. Version published to 10.1371/journal.pntd.0009156
  2. ScreenIT

    SciScore for 10.1101/2021.01.25.21250454: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationStudy selection: We worked with an information specialist to design an appropriate search strategy to identify original peer-reviewed articles of randomized controlled trials and observational studies evaluating the prevalence or mortality outcomes, or both of COVID-19 in ESRD patients with RRT (KT, HD, or PD) without restriction on age, gender, ethnicity, duration of chronic kidney disease, or previous treatment.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We prospectively registered the systematic review with PROSPERO International Prospective Register of Ongoing Systematic Reviews (Registration number: CRD42020199752).
    PROSPERO International Prospective
    suggested: None
    Search strategy: PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials were used to systematically search for articles published in the English language up to June 30, 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Additionally, the reference lists of included articles were searched, as well as related citations from other journals via Google Scholar.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    We regarded level of heterogeneity for I2 statistic as defined in chapter 9 of the Cochrane Handbook for Systematic Reviews of Interventions: 0–40% might not be important; 30–60% may represent moderate heterogeneity; 50–90% may represent substantial heterogeneity; 75–100% considerable heterogeneity.
    Cochrane Handbook
    suggested: None
    The meta-analysis was performed using STATA 16.1 (StataCorp, TX, USA).
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Several limitations of this systematic review and meta-analysis should be noted. First, the included studies had high heterogeneities for both prevalence and CFR outcomes. The subgroup analysis could not fully explore all sources of heterogeneity, given the limited availability of the information presented in the included studies. Second, there was no included study focused on ESRD patients with PD only. Thus, the prevalence and CFR of COVID-19 in PD patients might not be available. Third, we did not explore deeper into specific details of each RRT modality such as type of HD, type of KT, and duration of RRT. Lastly, we included only English language articles that might miss some pieces of evidence in other languages. In conclusion, our systematic review and meta-analysis provided the first evidence on the pooled prevalence and CFR of COVID-19 in ESRD patients with RRT which were higher than the global average. Increased prevalence and deaths might relate to reduced immune function in ESRD patients. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.01.25.21250454v1 on medRxiv