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Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies

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Abstract

Background

Kidney involvement is common in hospitalized coronavirus disease 2019 (COVID-19) patients during the acute phase, little is known about the long-term impact of COVID-19 on the kidney.

Methods

This is a systematic review and meta-analysis on long-term renal outcomes among COVID-19 patients. We carried out a systematic literature search in PUBMED, EMBASE, SCOPUS, and Cochrane COVID-19 study register and performed the random-effects meta-analysis of rates. The search was last updated on November 23, 2022.

Results

The study included 12 moderate to high-quality cohort studies involving 6976 patients with COVID-19-associated acute kidney injury and 5223 COVID-19 patients without acute kidney injury. The summarized long-term renal non-recovery rate, dialysis-dependent rate, and complete recovery rate among patients with COVID-19-associated AKI was 22% (12–33%), 6% (2–12%), and 63% (44–81%) during a follow-up of 90–326.5 days. Heterogeneity could be explained by differences in the prevalence of chronic kidney disease and proportion of acute kidney injury requiring renal replacement therapy using meta-regression; patients with more comorbidities or higher renal replacement therapy rate had higher non-recovery rates. The summarized long-term kidney function decrease rate among patients without acute kidney injury was 22% (3–51%) in 90–199 days, with heterogeneity partially explained by severity of infection.

Conclusion

Patients with more comorbidities tend to have a higher renal non recovery rate after COVID-19-associated acute kidney injury; for COVID-19 patients without acute kidney injury, decrease in kidney function may occur during long-term follow-up. Regular evaluation of kidney function during the post-COVID-19 follow-up among high-risk patients may be necessary.

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Data availability

The data underlying this article are available in the article and in its online supplementary material.

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Acknowledgements

We thank the authors of all included studies in this meta-analysis.

Funding

This is no funding for the current study.

Author information

Authors and Affiliations

  1. Renal Division, Peking University First Hospital, Beijing, China

    Yuhui Zhang, Youlu Zhao, Jinwei Wang, Xizi Zheng, Damin Xu, Jicheng Lv & Li Yang

  2. Institute of Nephrology, Peking University, Beijing, China

    Yuhui Zhang, Youlu Zhao, Jinwei Wang, Xizi Zheng, Damin Xu, Jicheng Lv & Li Yang

  3. Key Laboratory of Renal Disease, Ministry of Health, Beijing, China

    Yuhui Zhang, Youlu Zhao, Jinwei Wang, Xizi Zheng, Damin Xu, Jicheng Lv & Li Yang

  4. Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China

    Yuhui Zhang, Youlu Zhao, Jinwei Wang, Xizi Zheng, Damin Xu, Jicheng Lv & Li Yang

  5. Research Units of Diagnosis and Treatment of lmmune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China

    Li Yang

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  1. Yuhui Zhang
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Contributions

Research idea and study design: LY, YZ, JL; data acquisition: YZ, YZ; data analysis: YZ; manuscript drafting: YZ, manuscript revision: LY, JL, JW, YZ, XZ, DX; supervision or mentorship: LY. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions on the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Li Yang.

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The authors have no conflict of interest to declare. 

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Ethical approval was not required as this meta-analysis is a synthesis and analysis of existing studies.

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This meta-analysis does not contain any study with human participants or animals performed by any of the authors.

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Zhang, Y., Zhao, Y., Wang, J. et al. Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies. J Nephrol 36, 2441–2456 (2023). https://doi.org/10.1007/s40620-023-01731-8

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