Comorbid Kidney Disease Increases Risk of Severe COVID-19

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Patients with comorbid kidney disease and those on continuous renal replacement therapy (CRRT) are at increased risk of severe COVID-19, concludes a meta-analysis in Clinical and Experimental Medicine.

A systematic review of the literature was performed to identify studies providing information on comorbid chronic kidney disease (CKD), acute kidney injury (AKI), and CRRT and outcomes of hospitalized patients with laboratory-confirmed COVID-19. The meta-analysis included data from 29 observational studies including a total of 15,017 COVID-19 patients. The studies were published through August 2020, with 20 studies performed in China and 6 in the United States. Severe COVID-19 was defined in terms of intensive care unit (ICU) admission, oxygen saturation less than 90%, invasive mechanical ventilation, and in-hospital death.

Overall, 11.6% of patients had prevalent AKI, 9.7% had CKD, and 2.58% were receiving CRRT. On analysis of 13,278 patients from 22 studies, comorbid CKD was associated with increased odds of severe COVID-19: pooled odds ratio (OR) 1.7.

Based on 16 studies, including 3693 patients, comorbid CKD was associated with increased odds of severe COVID-19: OR 8.28. Meta-analysis of 3946 patients from 17 studies showed a significant association between CRRT and severe COVID-19: OR 16.90. Although pandemic COVID-19 primarily affects the lungs, kidney manifestations may also occur through unknown but likely multifactorial mechanisms. This meta-analysis of data available through August 2020 shows that AKI, CKD, and CRRT use are common among hospitalized patients with COVID-19 and are also associated with increased odds of severe disease [Singh J, et al. Kidney disease and COVID-19 disease severity—systematic review and meta-analysis. Clin Exp Med, published online ahead of print April 23, 2021. doi: 10.1007/s10238-021-00715-x;].