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Global Translational Medicine COVID-19 and acute kidney injury

developed acute kidney injury (AKI) despite having included. Studies focusing on severe acute respiratory
normal creatinine levels. 2 syndrome (SARS) and Middle East respiratory syndrome
While the severe acute respiratory syndrome coronavirus (MERS) but not COVID-19 were excluded.
2 (SARS-CoV-2) primarily affects the respiratory system, 2.3. Data collection
clinical findings from several deceased cases suggest that
other organs may also be involved. Given the limited For each eligible study, the following information was
2
information on kidney disease in COVID-19 patients, this recorded: first authors, study site, inclusion and exclusion
meta-analysis aims to determine the incidence of AKI in criteria, sample size, age, and sex of participants.
COVID-19 patients by pooling available published data. In A standardized data entry form was developed to focus
addition, we evaluated the association between markers of on the following areas: the total number of patients, the
abnormal kidney function and mortality in these patients. number of AKI patients, AKI-related indicators, according
Despite ongoing research, specific treatments for COVID- to AKI Network: (i) an increase in serum creatinine level
19-related kidney complications remain elusive. This of ≥0.3 mg/dL, (ii) an increase in baseline serum creatinine
review also explores potential pathogenic mechanisms to level to ≥150%), and AKI-related death (Tables 2 and 3).
inform future therapeutic interventions. 2.4. Data synthesis and statistical analysis

2. Data and methods The primary outcomes of our study included the incidence
of AKI in COVID-19-infected patients (Table 4), mortality
2.1. Literature search in patients who developed AKI (Table 5), clinical
We conducted a systematic review of the literature on symptoms, and markers of kidney injury.
COVID-19 and its association with AKI. The systematic For the AKI prevalence rates, data were pooled and
review was performed in accordance with the Preferred analyzed using SPSS and MedCalc. When two or more
Reporting Items for Systematic Reviews and Meta- studies with at least four patients reported the same
Analyses (PRISMA) guidelines. 3 outcome under the same definition, a random effects
Two authors independently performed a literature model was used. Double arcsine transformation was
search using PubMed, Web of Science, Embase, and the applied to pool the proportions. The results were presented
Cochrane Library. The search followed pre-specified using forest plots (Figure 1A and B), which illustrate the
criteria to include studies reporting clinic characteristics, prevalence, 95% confidence intervals, and weightings.
AKI incidence, mortality rates, and the risk of death Cochran’s Q test was used to detect heterogeneity, with a
2
associated with AKI during COVID-19 infection. The data P <0.10 indicating significant heterogeneity. The I statistic
were pooled for statistical analysis using MedCalc software was calculated to measure the proportion of total variation
to derive conclusions. 4 in study estimates attributable to heterogeneity, with I 2
>50% suggesting substantial heterogeneity.
A comprehensive literature search was performed
using both MeSH terms and free-text keywords, including 3. Results
“COVID-19”/“SARS-CoV-2,” “AKI”/“acute kidney injury,”
and “English language.” The databases searched included 3.1. Literature search and study selection
PubMed, Embase, Cochrane Library, Cochrane COVID- The PRISMA flow diagram (Figure 2) outlines the study
19 Study Register, Directory of Open Access Journals, and selection process. Initially, 1723 records were identified, with
Web of Science, covering publications up to June 8, 2023. an additional 11 records obtained from reference lists. After
The search strategy is presented in Table 1. Additional removing duplicates, 1535 records remained for screening. 2,5-7
relevant articles were identified by reviewing the reference
lists of the included studies. 3.2. Characteristics of included studies
Table 2 summarizes the basic characteristics of the four
2.2. Selection criteria studies included in the qualitative analysis, focusing on
All articles identified through the literature search were serum creatinine markers. 2,5,7,8 In addition, Table 6 presents
screened by two independent reviewers (M.S.S and R.J). the Newcastle-Ottawa scores for the included studies.
We included studies on COVID-19 in adult patients. Full
articles, conference abstracts, case reports, case series, non- 3.3. Publication bias
randomized studies, randomized trials, and observational Publication bias was assessed using funnel plot analysis
studies published in English were included in this review. (Figure 3), which indicated no evidence of bias among the
Commentaries, letters to editors, and editorials were also included studies. 2,5-8

Volume 3 Issue 3 (2024) 2 doi: 10.36922/gtm.2798