Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Department of Public Health, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, USA.
Clin Exp Med. 2022 Feb;22(1):125-135. doi: 10.1007/s10238-021-00715-x. Epub 2021 Apr 23.
We aimed to identify prevalence and association of comorbid chronic kidney disease (CKD), acute kidney injury (AKI) and utilization prevalence of continuous renal replacement therapy (CRRT) in COVID-19-hospitalized patients as a function of severity status. With the ongoing struggle across the globe to combat COVID-19 disease, published literature has described the role of kidney disease in COVID-19 patients based on single/multicenter experiences across the globe. We extracted data from observational studies describing comorbid CKD, AKI and CRRT and outcomes and severity of COVID-19-hospitalized patients from December 1, 2019-August 20, 2020 following PRISMA guidelines. Severity of COVID-19 includes intensive care unit admission, oxygen saturation < 90%, invasive mechanical ventilation utilization, in-hospital admission and mortality. Meta-analysis was performed using a random-effects model to calculate pooled estimates, and forest plots were created. In total, 29 studies with 15,017 confirmed COVID-19 patients were included. The overall prevalence of AKI was 11.6% [(430/3693)], comorbid CKD 9.7% [(1342/13,728)] and CRRT 2.58% [(102/3946)] in our meta-analysis. We also found higher odds of comorbid CKD (pooled OR: 1.70; 95%CI: 1.21-2.40; p = 0.002), AKI (8.28; 4.42-15.52; p < 0.00001) and utilization of CRRT (16.90; 9.00-31.74; p < 0.00001) in patients with severe COVID-19 disease. Conclusion Our meta-analysis suggests that comorbid CKD, AKI and utilization of CRRT were significantly associated with COVID-19 disease severity. Clinicians should focus on early triaging of COVID-19 patients with comorbid CKD and at risk for AKI to prevent complication and mortality.
我们旨在确定 COVID-19 住院患者中合并存在的慢性肾脏病 (CKD)、急性肾损伤 (AKI) 和连续性肾脏替代治疗 (CRRT) 的患病率及其与疾病严重程度的关联。在全球范围内持续努力抗击 COVID-19 疾病的过程中,已发表的文献基于全球范围内的单中心或多中心经验,描述了肾脏疾病在 COVID-19 患者中的作用。我们按照 PRISMA 指南,从 2019 年 12 月 1 日至 2020 年 8 月 20 日期间,提取了描述 COVID-19 住院患者合并存在 CKD、AKI 和 CRRT 以及疾病严重程度的观察性研究的数据。COVID-19 严重程度包括入住重症监护病房、氧饱和度 < 90%、使用有创机械通气、住院和死亡。采用随机效应模型进行荟萃分析,以计算汇总估计值,并绘制森林图。共有 29 项研究纳入了 15017 例确诊的 COVID-19 患者。我们的荟萃分析中,AKI 的总体患病率为 11.6%(430/3693),合并 CKD 的患病率为 9.7%(1342/13728),CRRT 的患病率为 2.58%(102/3946)。我们还发现,合并存在 CKD 的患者发生 AKI 的可能性更高(汇总 OR:1.70;95%CI:1.21-2.40;p = 0.002)、发生 AKI 的可能性更高(汇总 OR:8.28;4.42-15.52;p < 0.00001)和使用 CRRT 的可能性更高(汇总 OR:16.90;9.00-31.74;p < 0.00001),提示这些患者的 COVID-19 疾病更严重。结论我们的荟萃分析表明,合并存在 CKD、AKI 和使用 CRRT 与 COVID-19 疾病严重程度显著相关。临床医生应重点关注合并存在 CKD 和有发生 AKI 风险的 COVID-19 患者的早期分诊,以预防并发症和死亡。
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