Incidence and prognosis of COVID-19 in people with CKD

Background: Coronavirus-disease-2019 (COVID19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID19 in people with CKD. Methods: We searched MEDLINE, EMBASE and PubMed through February 2021 for cohort and case-control studies measuring the incidence or outcomes of COVID19 in people with CKD. We extracted data on COVID19 incidence, death, respiratory failure, dyspnoea, COVID19 recovery, intensive care admission, acute dialysis, and acute kidney injury. Certainty evidence was adjudicated using GRADE. Results: We included 348 studies (382407 participants with COVID19, 1139979 with CKD). In low-certainty evidence, the incidence of COVID19 was higher in people with dialysis-dependent CKD (105/10000-person-weeks [pw];95% confidence interval [CI] 91-120;95% prediction interval [PrI] 25-235;59 studies;468233 participants) than pre-dialysis CKD (16/10000-pw;CI 4-33;PrI 0-92;5 studies;70683 participants) and kidney transplant recipients (KTRs) (23/10000-pw;CI 18-30;PrI 2-67;29 studies;120281 participants). In low-certainty evidence, the incidence of death in people with CKD and COVID19 may be higher than those without COVID19 (incidence rate ratio 10.26;CI 6.78-15.53;PrI 2.62-40.15;4 studies;18347 participants). In low/very lowcertainty evidence, people with CKD may experience a high incidence of other outcomes (Table 1). Conclusions: The incidence of COVID19 may be higher in people with dialysisdependent CKD compared to pre-dialysis CKD or KTRs. People with CKD and COVID19 may have a higher incidence of death than those without COVID19.