COVID-19 and CKD: An overview of reviews to inform the world health organization scientific brief

ABSTRACT

Background: The World Health organization (WHO) declared COVID-19 as a global pandemic in March of 2020. Many studies have assessed the association between different comorbidities and COVID-19 outcomes. In this overview of reviews, we aim to summarize the association between CKD and different COVID-19 outcomes. Methods: We performed a systematic search through Embase, PubMed, Epistemonikos, and Cochrane as well as preprint databases from January 1, 2020 to January 5, 2021. After searching systematic reviews, we updated the search by identifying primary studies published after August 2020, which was the date of last search in the reviews. We focused on systematic reviews and large primary studies. We followed the GRADE methodology to assess the certainty in effect estimates. Data was pooled based on random effects model. Results: We included a total of 69 systematic reviews and 66 primary studies in our overview. We did not identify any systematic reviews that directly reports on CKD and the risk of contracting COVID-19. There was no convincing difference on the risk of acquiring COVID-19 infection in patients with and without CKD in primary studies (OR = 1.00, 95% CI 0.76-1.33). CKD is associated with higher risk of COVID-19 related mortality pooled hazard ratio (HR) 1.48 (95% CI 1.33-1.65) and pooled odds ratio (OR) 1.77 (95% CI 1.54-2.02)(moderate certainty), hospitalization pooled risk ratio (RR) 1.63 (95% CI 1.03-2.58) (moderate certainty) and disease severity pooled RR 1.56 (95% CI 1.3-1.86) (moderate certainty). Notably, the risk of COVID-19 attributed hospitalization and mortality were higher in patients with more advanced CKD stage. Conclusions: Evidence consistently demonstrated an increased risk of mortality, hospitalization and disease severity in patients with CKD and COVID-19 infection. The results highlight the importance of recognizing patients with CKD as a high-risk group and of prioritizing these patients for COVID-19 prevention strategies including vaccination.