Chronic Kidney Disease and COVID-19 Mortality: A Systematic Review and Meta-Analysis

Abstract

Introduction: The outbreak of the coronavirus disease 2019 (COVID-19) has caused a pandemic and continues to a play a role in the increasing mortality rates among high-risk populations such as individuals with comorbidities like cardiovascular disease, diabetes, and chronic kidney disease (CKD). In patients diagnosed with CKD, infections are a significant factor which contribute to mortality second only to cardiovascular complications. The aim of this review was to conduct a systematic review and meta-analyses to evaluate the mortality associated with CKD in patients diagnosed with COVID-19 and to stratify the effect estimates by sample size, progression of CKD (stages III-V only), or end-stage kidney disease (ESKD).Methods: We searched the most updated and highest quality systematic reviews for primary articles and subsequently conducted a comprehensive systematic search of the Embase, PubMed, Epistemonikos, Cochrane, and Google Scholar databases from Sep 1st, 2020 to Jan 10th, 2021 for published articles. We also performed a search of the LiTCOVID, MEDRXIV, and SSRN databases for preprints of unpublished studies from Jan 1st, 2020 to Jan 5th, 2021. Results: We identified 75 studies that reported effect estimates for mortality for patients diagnosed with COVID-19 and CKD. Mortality was significantly higher among patients with CKD and COVID-19 than their counterparts without CKD (HR 1.57, 95% CI [1.42, 1.73], P < 0.00001; OR 1.86, 95% CI [1.64, 2.11], P < 0.00001; RR 1.74, 95% CI [1.13, 2.69], P = 0.01). The subgroup analyses investigating the effect of CKD stage (III-V) revealed increased mortality (HR 2.02 (95% CI [1.39, 2.94], P = 0.0002) as well as those analyzing the effect of ESKD (HR 1.92, 95% CI [0.96, 3.81], P = 0.06; OR 1.44, 95% CI [1.15, 1.81], P = 0.002). Regardless of study sample size, the trend of increased mortality in patients with CKD and COVID-19 was apparent. Conclusion: Our findings demonstrated that patients diagnosed with CKD or ESKD have an increased risk of mortality and that COVID-19 management strategies as well as policies should prioritize patients with CKD or ESKD.