The chronic kidney disease and acute kidney injury involvement in COVID-19 pandemic: A systematic review and meta-analysis

  1. Ya-Fei Liu
  2. Zhe Zhang
  3. Xiao-Li Pan
  4. Guo-Lan Xing
  5. Ying Zhang
  6. Zhang-Suo Liu
  7. Sheng-Hao Tu

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Abstract

Currently, the SARS-CoV-2 promptly spread across China and around the world. However, there are controversies about whether preexisting chronic kidney disease (CKD) and acute kidney injury complication (AKI) are involved in the COVID-19 pandemic.

Measurements

Studies reported the kidney outcomes in different severity of COVID-19 were included in this study. Standardized mean differences or odds ratios were calculated by employing Review Manager meta-analysis software.

Results

Thirty-six trials were included in this systematic review with a total of 6395 COVID-19 patients. The overall effects indicated that preexisting CKD (OR = 3.28), complication of AKI (OR = 11.02), serum creatinine (SMD = 0.68), abnormal serum creatinine (OR = 4.86), blood urea nitrogen (SMD = 1.95), abnormal blood urea nitrogen (OR = 6.53), received continuous renal replacement therapy (CRRT) (OR = 23.63) were significantly increased in severe group than that in nonsevere group. Additionally, the complication of AKI (OR = 13.92) and blood urea nitrogen (SMD = 1.18) were remarkably elevated in the critical group than that in the severe group.

Conclusions

CKD and AKI are susceptible to occur in patients with severe COVID-19. CRRT is applied frequently in severe COVID-19 patients than that in nonsevere COVID-19 patients. The risk of AKI is higher in the critical group than that in the severe group.

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  1. Version published to 10.1371/journal.pone.0244779
  2. ScreenIT

    SciScore for 10.1101/2020.04.28.20083113: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The following English databases were retrieved to confirm trials: PubMed and medRxiv.gov.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)

    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 the included studies should be concerned. First, all the included studies did not stage CKD. Different CKD stage could have different risks for COVID-19 and have different prognosis. Second, only one study[9] reported the AKI stage which reflects the AKI severity, progression, and prognosis. AKI occurred primarily or AKI on CKD is unknown for the included studies. Third, all the included studies did not qualify the 24h total urine protein. Therefore, it is difficult to judge the severity of potential kidney diseases. Fourth, all the included studies did not measure the 24h urine volume or the change of urine volume which is beneficial for the diagnosis of AKI. Only two studies reported the urine routine[15,39]. Finally, the outcomes of AKI were unclear. Several limitations of this study should be noticed. First, all the included trials were conducted in Chinese populations, which inferred a high risk of selection bias. Second, most of the studies were of poor quality except four studies. Third, the heterogeneity was significant in terms of serum creatinine and blood urea nitrogen. The different disease severity, different sample size, different detection methods, and reference range were responsible for the heterogeneity. Fourth, the children or teenagers COVID-19 patients were probably included in this study because the included studies did not clearly restrict to adult COVID-19 patients. Fifth, the quality of the most of included studies was low which...

    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 10.1101/2020.04.28.20083113v1 on medRxiv