Incidence and risk factors of kidney impairment on patients with COVID-19: A meta-analysis of 10180 patients

  1. Qixin Yang
  2. Xiyao Yang

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Abstract

The novel coronavirus is pandemic around the world. Several researchers have given the evidence of impacts of COVID-19 on the respiratory, cardiovascular and gastrointestinal system. Studies still have debated on kidney injury of COVID-19 patients. The purpose of the meta-analysis was to evaluate the association of kidney impairment with the development of COVID-19.

Methods

The PubMed, Embase and MedRxiv databases were searched until May 1, 2020. We extracted data from eligible studies to summarize the clinical manifestations and laboratory indexes of kidney injury on COVID-19 infection patients and further compared the prevalence of acute kidney injury (AKI) and the mean differences of three biomarkers between in ICU/severe and non-ICU/non-severe cases. Heterogeneity was evaluated using the I 2 method.

Results

In the sum of 24 studies with 10180 patients were included in this analysis. The pooled prevalence of AKI, increased serum creatinine (Scr), increased blood urea nitrogen (BUN), increased D-dimer, proteinuria and hematuria in patients with COVID-19 were 16.2%, 8.3%, 6.2%, 49.8%, 50.1% and 30.3% respectively. Moreover, the means of Scr, BUN and D-dimer were shown 6.4-folds, 1.8-folds and 0.67-folds, respectively, higher in ICU/severe cases than in corresponding non-ICU/non-severe patients. The prevalence of AKI was about 30 folds higher in ICU/severe patients compared with the non-ICU/non-severe cases.

Conclusions

Overall, we assessed the incidences of the clinic and laboratory features of kidney injury in COVID-19 patients. And kidney dysfunction may be a risk factor for COVID-19 patients developing into the severe condition. In reverse, COVID-19 can also cause damage to the kidney.

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  1. Version published to 10.1371/journal.pone.0241953
  2. ScreenIT

    SciScore for 10.1101/2020.05.28.20116400: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationInclusion criteria are as follows:(1) comparative studies: randomized controlled trials RCTs or non-RCTs published only restricted in English; (2) patients in the studies should be confirmed to have been infected by COVID-19; (3)studies containing information about the clinical or laboratory characteristics (4) studies containing the comorbidities of kidney dysfunction and the outcome of kidney impairment.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Our study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses of individual participant data (the PRISMA-IPD) statement15 Data source, search strategy and selection criteria: PubMed, EMBASE, and MedRxiv databases were applied for searching studies published from December 2019 to April 2020 in China.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    MedRxiv
    suggested: (medRxiv, RRID:SCR_018222)
    Cochrane Collaboration’s tool was applied to evaluate the risk of bias.
    Cochrane Collaboration’s
    suggested: None

    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:
    However, there are still some limitations for this meta-analysis. Firstly, due to the information missing from the literature, we hardly could include study compared the complications of kidney injury between ICU/severe and non-ICU/non-severe patients. In which cases, we did not perform sensitivity analysis and subgroup analysis for proteinuria, hematuria or uric acid. Secondly, we found that the high statistic heterogeneity in the prevalence of kidney injury analysis. The reasons are related to the study designs and significant variations among studies in the sample sizes. Thirdly, therapies under investigation for COVID-19 may have kidney side effects as lots of drugs are nephrotoxic such as aminoglycosides, ACE inhibitors and nonsteroidal anti-inflammatory drugs(NSAIDs), we are not sure whether some clinical data we got have such possibility involved, and we could not rule out the influences caused by drugs on kidney during the hospitalization. There are some explanations for kidney injury during the COVID-19 infection episodes. Firstly, ACE-2 distributes on tubular epithelial cells of the kidney with a higher expression level compared to the lung. Thus, the kidney is also a direct aim organ attacked by SARS-CoV-2 entering into target cells through ACE-2 acting as the way in the lung. Secondly, the crosstalk relationship between lung and kidney. Kidney damage can be caused by circulating inflammatory factors such as tumor necrosis factor (TNF)-α and interleukin (IL)-6, whi...

    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.
    • No protocol registration statement was detected.

    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 10.1101/2020.05.28.20116400v1 on medRxiv