Renal involvement in coronavirus disease 2019 (record): A systematic review and meta-analysis

Background: COVID-19 caused substantial casualty worldwide As the reported renal involvement varied across regions, we sought to review the global prevalence of renal manifestations among COVID-19 patients and determine the risk factors associated with AKI Methods: We systematically searched 6 databases for peer-reviewed reports and 7 data portals for grey literature for all trials, cohorts, case-control studies and case-series that reported the prevalence of renal manifestations including AKI, RRT, proteinuria and hematuria, and their associated risk factors All papers were screened, assessed and extracted by at least 2 researchers independently Quality was assessed according to NIH assessment tools To avoid duplicate of patient data, we matched the location, institution and time period, and only included the largest data source if studies overlapped Prevalence of renal manifestations was pooled from studies that consecutively recruited patients from the general population, and with clear definition of outcome This review was prospectively registered at PROSPERO (CRD42020184621) Results: 36 studies from 8 countries and over 50 cities with a total of 14,712 patients were identified 34 and 2 were cohorts and case-control studies respectively 24, 7 and 5 studies reported COVID-19 patients from the general population, severe / critical patients and patients with history of RRT AKI occurred in 14 3% of all COVID-19 cases and was highest in New York City 4 7% of hospitalized COVID-19 patients underwent RRT Proteinuria and hematuria were present in 42 5% and 26 7% of all COVID-19 cases The odds of mortality among COVID-19 patients who developed AKI was 15 times higher than non-AKI COVID-19 patients (pooled OR=16 85, 95% CI: 10 06 to 28 23, 2 cities, 6 studies, 9,297 patients) and was higher in Hubei Such effect was not observed among kidney transplant patients (pooled OR=0 95, 95% CI: 0 12 to 7 22, 2 studies, 30 patients) Higher C-reactive protein, leukocyte count, serum lactate dehydrogenase and creatinine levels on admission were associated with AKI Conclusions: AKI was prevalent among COVID-19 patients and significantly associated with mortality The odds of mortality among AKI patients varied significantly between cities, which could be associated with differences in healthcare infrastructure and delayed hospitalization and treatment initiation