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Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis
  1. Panupong Hansrivijit1,
  2. Chenchen Qian1,
  3. Boonphiphop Boonpheng2,
  4. Charat Thongprayoon3,
  5. Saraschandra Vallabhajosyula4,
  6. Wisit Cheungpasitporn5,
  7. Nasrollah Ghahramani6
  1. 1 Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
  2. 2 Division of Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  3. 3 Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
  6. 6 Division of Nephrology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Panupong Hansrivijit, Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, PA 17101-2010, USA; hansrivijitp{at}


Acute kidney injury (AKI) is a complication of COVID-19. However, the incidence of AKI in COVID-19 varies among studies. Thus, we aimed to evaluate the pooled incidence of AKI and its association with mortality in patients with COVID-19 using a meta-analysis. We search Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible publications reporting the clinical characteristics of patients with COVID-19 without language restriction. Incidence of AKI and mortality were reported. Meta-regression was used to describe the association between outcomes. From 26 studies (n=5497), the pooled incidence of AKI in patients with COVID-19 was 8.4% (95% CI 6.0% to 11.7%) with a pooled incidence of renal replacement therapy of 3.6% (95% CI 1.8% to 7.1%). The incidence of AKI was higher in critically ill patients (19.9%) compared with hospitalized patients (7.3%). The pooled estimated odds ratio for mortality from AKI was 13.33 (95% CI 4.05 to 43.91). No potential publication bias was detected. By using meta-regression analyses, the incidence of AKI was positively associated with mortality after adjusted for age and sex (Q=26.18; p=0.02). Moreover, age (p<0.01), diabetes (p=0.02), hypertension (p<0.01) and baseline serum creatinine levels (p=0.04) were positively associated with AKI incidence in adjusted models. In conclusion, AKI is present in 8.3% of overall patients with COVID-19 and in 19.9% of critically ill patients with COVID-19. Presence of AKI is associated with 13-fold increased risk of mortality. Age, diabetes, hypertension, and baseline serum creatinine levels are associated with increased AKI incidence.

  • acute kidney injury
  • death
  • kidney diseases
  • kidney

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  • Contributors PH and WC performed literature search. PH, CQ, BB, and CT performed citation screening and data collection. PH analyzed the data. PH, CQ and BB drafted the manuscript. All authors edited the manuscript. PH, SV, WC and NG revised the full text for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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 supplementary information.