Department of Urology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China.
Ren Fail. 2022 Dec;44(1):415-425. doi: 10.1080/0886022X.2022.2046609.
Hydroxychloroquine/chloroquine has been widely used as part of the standard treatment for patients with coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to determine whether hydroxychloroquine/chloroquine increases the risk of acute kidney injury (AKI) in COVID-19 patients.
PubMed and Embase were searched for related publications from inception to Dec 31, 2021, including randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) comparing the risk of AKI and/or increased creatinine in COVID-19 patients receiving hydroxychloroquine/chloroquine and other controls (active treatment and placebo). We conducted separate meta-analyses for RCTs and NRSIs based on fixed-effect model, with odds ratios (ORs) being considered as effect sizes.
We included 21 studies in the analysis, with 12 were RCTs. Based on the RCTs, compared to placebo, the OR was 1.19 (95% confidence interval [CI]: 0.86, 1.64; = .30, = 4, moderate quality) for AKI and 1.00 (95%CI: 0.64, 1.56; = .99, = 5, moderate quality) for increased creatinine for patients received hydroxychloroquine/chloroquine treatment; compared to active treatment, the odds was 1.28 (95%CI: 0.65, 2.53; = .47, = 2, low quality) for AKI and 0.64 (95%CI: 0.13, 3.20; = .59, = 1, low quality) for increased creatine. Evidence from NRSIs showed slightly increased odds of AKI, with low quality.
Based on current available studies which were graded as low to moderate quality, there is insufficient evidence to conclude that hydroxychloroquine/chloroquine use is associated with increased risk of AKI or raised creatinine. AKI: acute kidney injury; COVID-19: Coronavirus Disease 2019; RCT: randomized controlled trials; NRSI: non-randomized studies of interventions; OR: odds ratios; ROBIS-I: Risk Of Bias In Non-randomized Studies - of Interventions.
羟氯喹/氯喹已被广泛用作 2019 年冠状病毒病（COVID-19）患者标准治疗的一部分。我们进行了一项系统评价和荟萃分析，以确定羟氯喹/氯喹是否会增加 COVID-19 患者急性肾损伤（AKI）的风险。
从研究开始到 2021 年 12 月 31 日，我们在 PubMed 和 Embase 上搜索了相关文献，包括比较 COVID-19 患者接受羟氯喹/氯喹和其他对照组（活性治疗和安慰剂）治疗后 AKI 和/或肌酐升高风险的随机对照试验（RCT）和非随机干预研究（NRSI）。我们根据固定效应模型对 RCT 和 NRSI 进行了单独的荟萃分析，以优势比（OR）作为效应量。
我们的分析纳入了 21 项研究，其中 12 项为 RCT。基于 RCT，与安慰剂相比，接受羟氯喹/氯喹治疗的患者 AKI 的 OR 为 1.19（95%置信区间[CI]：0.86，1.64； = .30， = 4，中等质量），肌酐升高的 OR 为 1.00（95%CI：0.64，1.56； = .99， = 5，中等质量）；与活性治疗相比，AKI 的优势比为 1.28（95%CI：0.65，2.53； = .47， = 2，低质量），肌酐升高的优势比为 0.64（95%CI：0.13，3.20； = .59， = 1，低质量）。来自 NRSI 的证据表明，AKI 的优势略有增加，但质量较低。
基于目前质量等级为低至中等的现有研究，没有足够的证据表明使用羟氯喹/氯喹会增加 AKI 或肌酐升高的风险。AKI：急性肾损伤；COVID-19：2019 年冠状病毒病；RCT：随机对照试验；NRSI：非随机干预研究；OR：优势比；ROBIS-I：非随机干预研究的偏倚风险。
