COVID–19 and chronic kidney disease: an updated overview of reviews

Abstract

Background: Coronavirus disease (COVID–19) has resulted in the death of more than 3.5 million people worldwide. While COVID–19 mostly affects the lungs, different comorbidities can have an impact on its outcomes. We performed an overview of reviews to assess the effect of Chronic Kidney Disease (CKD) on contracting COVID–19, hospitalization, mortality, and disease severity. Methods: We searched published and preprint databases. We updated the reviews by searching for primary studies published after August 2020, and prioritized reviews that are most updated and of higher quality using the AMSTAR tool. Results: We included 69 systematic reviews and 66 primary studies. Twenty-eight reviews reported on the prevalence of CKD among patients with COVID–19, which ranged from 0.4 to 49.0%. One systematic review showed an increased risk of hospitalization in patients with CKD and COVID–19 (RR = 1.63, 95% CI 1.03–2.58) (Moderate certainty). Primary studies also showed a statistically significant increase of hospitalization in such patients. Thirty-seven systematic reviews assessed mortality risk in patients with CKD and COVID–19. The pooled estimates from primary studies for mortality in patients with CKD and COVID–19 showed a HR of 1.48 (95% CI 1.33–1.65) (Moderate certainty), an OR of 1.77 (95% CI 1.54–2.02) (Moderate certainty) and a RR of 1.6 (95% CI 0.88–2.92) (Low certainty). Conclusions: Our review highlights the impact of CKD on the poor outcomes of COVID–19, underscoring the importance of identifying strategies to prevent COVID–19 infection among patients with CKD. Graphical abstract: [Figure not available: see fulltext.].