Article Text

Original research
Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis
  1. Lirong Lin1,
  2. Xiang Wang2,
  3. Jiangwen Ren3,
  4. Yan Sun1,
  5. Rongjie Yu1,
  6. Kailong Li1,
  7. Luquan Zheng1,
  8. Jurong Yang1
  1. 1Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, Chongqing, China
  2. 2Ultrasound, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, Chongqing, China
  3. 3Nephrology, Jiulongpo People's Hospital of Chongqing, Chongqing, China
  1. Correspondence to Dr Jurong Yang; 650230{at}


Objective To analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19.

Design Meta-analysis.

Data sources PubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020.

Study selection Studies examining the following demographics and outcomes were included: patients’ age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection.

Results A total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92–4.25) and an OR of 6.07, 95% CI (2.53–14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83–15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13–13.36).

Conclusion AKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.

  • nephrology
  • kidney & urinary tract disorders
  • acute renal failure

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  • Contributors JR and LL conceived the study, performed literature searches, extracted the data, assessed the quality of the studies and drafted the manuscript. XW and RJW performed literature searches. YS and KL performed the statistical analysis and drafted the manuscript. JY and LZ drafted the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by the Basic and Frontier Research ProgramProgramme of Chongqing (cstc2017jcyjBX0014, cstc2019jscx-msxmX0166) and grants from the National Natural Science Foundation of China (81770682).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information. All data are inside the paper.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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