MO301: The Incremental Chronic Kidney Disease Risk Among Post-Hospitalized Leptospirosis Patients With Acute Kidney Injury: Systematic Review And Meta-Analysis

Abstract

BACKGROUND AND AIMS: Leptospirosis is a global zoonotic bacterial disease that may cause life-threatening complications, such as acute kidney injury (AKI). Patients with AKI may recover fully, but some can progress to chronic kidney disease (CKD) or even become dialysis-dependent. This study aims to evaluate the CKD and dialysis-dependent incidences and risks among post-hospitalized leptospirosis patients with AKI. METHOD: Comprehensive searching was performed through the online databases of Pubmed, EMBASE, ScienceDirect and The Cochrane Library to include all relevant literature from 2000 to 2021. This study followed the PRISMA guidelines. The inclusion criteria are all observational studies that assess the incidence and risk for CKD development and dialysis dependence among post-hospitalized leptospirosisassociated AKI patients. The quality of included studies was accessed by using the Newcastle-Ottawa Scale. Analysis was conducted to obtain the pooled odds ratio (OR) with a 95% confidence interval (CI) with a fixed-effect heterogeneity test. RESULTS: Five observational studies met the inclusion criteria. About 7%-14% of post-hospitalized leptospirosis patients with AKI deteriorate significantly to become CKD risk (pooled OR = 1.78, 95% confidence interval 1.41-2.23; P < .0001, I2 = 0%). A population cohort study suggested that Leptospira-seropositive population is correlated with the eGFR decline, even in the non-diabetic subgroup. Multivariate analysis from a cohort study showed that the elderly patients were predictors of dialysis-dependency and mortality. The funnel plot is symmetrical suggesting no publication bias. CONCLUSION: Post-hospitalized leptospirosis with AKI patients has an incremental CKD risk. However, further studies are warranted to confirm the association and causality.