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High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis
  1. Camila Barbosa Oliveira1,2,
  2. Camilla Albertina Dantas Lima1,3,
  3. Gisele Vajgel1,2,
  4. Antonio Victor Campos Coelho4,
  5. Paula Sandrin-Garcia1,4
  1. 1 Keizo Azami Immunopathology Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
  2. 2 Department of Nephrology, Universidade Federal de Pernambuco, Recife, Brazil
  3. 3 Department of Oceanography, Universidade Federal de Pernambuco, Recife, Brazil
  4. 4 Department of Genetics, Universidade Federal de Pernambuco, Recife, Brazil
  1. Correspondence to Dr Camila Barbosa Oliveira, Nephrology, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil; camilabarbosalyra{at}


Aims Hospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI.

Methods We systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model.

Results From 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%–100%).

Conclusion The present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients’ outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.

  • kidney
  • viruses
  • death
  • epidemiology

Data availability statement

All data relevant to the study are included in the article.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

All data relevant to the study are included in the article.

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  • Handling editor Tahir S Pillay.

  • CBO and CADL contributed equally.

  • Contributors CBO and CADL contributed equally to this study. CBO, CADL, GV and PSG designed the study, had full access to all results and take responsibility for the accuracy of the data analysis. CBO and CADL performed the articles search and selection. CBO, CADL and GV interpreted the data and drafted the manuscript. AVCC did the statics analysis. PSG and AVCC revised the manuscript. PSG conceived the idea and supervised the study. All authors read and approved the final manuscript.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.