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Abstract: PO0661

Renal Involvement in Coronavirus Disease 2019 (RECORD): A Systematic Review and Meta-Analysis

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Chan, Kam wa, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
  • Yu, Kam Yan, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
  • Lee, Pak Wing, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, London, United Kingdom
  • Tang, Sydney C.W., Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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.

Conclusion

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.