COVID-19 相关的肾脏并发症：一项系统回顾和荟萃分析。
Renal complications in COVID-19: a systematic review and meta-analysis.
机构信息
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK.
出版信息
Ann Med. 2020 Nov;52(7):345-353. doi: 10.1080/07853890.2020.1790643. Epub 2020 Jul 10.
PURPOSE
Emerging data suggest that coronavirus disease 2019 (COVID-19) has extrapulmonary manifestations but its renal manifestations are not clearly defined. We aimed to evaluate renal complications of COVID-19 and their incidence using a systematic meta-analysis.
DESIGN
Observational studies reporting renal complications in COVID-19 patients were sought from MEDLINE, Embase and the Cochrane Library from 2019 to June 2020. The nine-star Newcastle-Ottawa Scale was used to evaluate methodological quality. Incidence with 95% confidence intervals (CIs) were pooled using random-effects models.
RESULTS
We included 22 observational cohort studies comprising of 17,391 COVID-19 patients. Quality scores of studies ranged from 4 to 6. The pooled prevalence of pre-existing chronic kidney disease (CKD) and end-stage kidney disease was 5.2% (2.8-8.1) and 2.3% (1.8-2.8), respectively. The pooled incidence over follow-up of 2-28 days was 12.5% (10.1-15.0) for electrolyte disturbance (e.g. hyperkalaemia), 11.0% (7.4-15.1) for acute kidney injury (AKI) and 6.8% (1.0-17.0) for renal replacement therapy (RRT). In subgroup analyses, there was a higher incidence of AKI in US populations and groups with higher prevalence of pre-existing CKD.
CONCLUSIONS
Frequent renal complications reported among hospitalized COVID-19 patients are electrolyte disturbance, AKI and RRT. Aggressive monitoring and management of these renal complications may help in the prediction of favourable outcomes. PROSPERO 2020: CRD42020186873 KEY MESSAGES COVID-19 affects multiple organs apart from the respiratory system; however, its renal manifestations are not clearly defined. In this systematic meta-analysis of 22 observational cohort studies, the prevalence of pre-existing chronic kidney disease (CKD) in COVID-19 patients was 5.2%. The most frequent renal complication was electrolyte disturbance (particularly hyperkalaemia) with an incidence of 12.5% followed by acute kidney injury (AKI) with an incidence of 11.0%; US populations and groups with higher prevalence of CKD had higher incidence of AKI.
目的
新出现的数据表明，2019 年冠状病毒病（COVID-19）有肺外表现，但肾脏表现尚不清楚。我们旨在通过系统的荟萃分析评估 COVID-19 的肾脏并发症及其发生率。
设计
从 2019 年至 2020 年 6 月，从 MEDLINE、Embase 和 Cochrane 图书馆中检索了报道 COVID-19 患者肾脏并发症的观察性研究。使用 9 星纽卡斯尔-渥太华量表评估方法学质量。使用随机效应模型汇总 95%置信区间（CI）的发生率。
结果
我们纳入了 22 项观察性队列研究，共纳入了 17391 例 COVID-19 患者。研究的质量评分范围为 4 至 6 分。预先存在的慢性肾脏病（CKD）和终末期肾脏病的合并患病率分别为 5.2%（2.8-8.1）和 2.3%（1.8-2.8）。在 2-28 天的随访中，电解质紊乱（如高钾血症）的合并发生率为 12.5%（10.1-15.0），急性肾损伤（AKI）为 11.0%（7.4-15.1），肾脏替代治疗（RRT）为 6.8%（1.0-17.0）。亚组分析显示，美国人群和预先存在 CKD 患病率较高的人群中 AKI 的发生率较高。
结论
在住院 COVID-19 患者中报告的频繁肾脏并发症为电解质紊乱、AKI 和 RRT。积极监测和管理这些肾脏并发症可能有助于预测良好的结局。PROSPERO 2020：CRD42020186873 主要信息 COVID-19 除了影响呼吸系统外，还会影响多个器官；然而，其肾脏表现尚不清楚。在这项对 22 项观察性队列研究的系统荟萃分析中，COVID-19 患者预先存在的慢性肾脏病（CKD）的患病率为 5.2%。最常见的肾脏并发症是电解质紊乱（特别是高钾血症），发生率为 12.5%，其次是急性肾损伤（AKI），发生率为 11.0%；美国人群和 CKD 患病率较高的人群 AKI 发生率较高。
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