GLOBAL GEOGRAPHIC AND SOCIO-ECONOMIC DISPARITIES IN COVID-ASSOCIATED ACUTE KIDNEY INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction:

Acute Kidney Injury (AKI) is a common and severe complication of COVID, which significantly increases the risk of mortality. There has been a wide range of AKI reported throughout the pandemic, ranging from 4.5% to 29% [1,2], reflecting differences in geographic location, patient characteristics and healthcare resources. This systematic review and meta-analysis aim to provide a global overview of the COVID AKI prevalence reported in published studies with a focus on uncovering geographic and socio-economic disparities.

1. Yang X, Jin Y, Li R, Zhang Z, Sun R, Chen D. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and meta-analysis. Critical Care. 2020/06/18 2020;24(1):356. doi:10.1186/s13054-020-03065-4 

2. Zhang J, Pang Q, Zhou T, Meng J, Dong X, Wang Z, Zhang A. Risk factors for acute kidney injury in COVID-19 patients: an updated systematic review and meta-analysis. Renal Failure. 2023/12/31 2023;45(1):2170809. doi:10.1080/0886022X.2023.2170809 

Methods:

We systematically searched PubMed, Embase, Scopus, Web of Science and Cochrane Library for full-text articles available in English published from January 2020 to November 2023. Clinical characteristics were extracted and examined from 334 studies that met the inclusion criteria. AKI was defined according to KDIGO criteria in all studies. After removing studies that utilised the same data, 351,934 patients from 245 studies were included. With significant study heterogeneity, random-effect models were used for the meta-analysis. Sub-group analysis was conducted by country, region and income level. 

Results:

This systematic review and meta-analysis cover studies from 49 countries. The pooled COVID AKI prevalence was 0.24 [0.21,0.26] for studies that included general hospitalised patients. For Intensive Care Unit (ICU) only studies, the pooled AKI prevalence was 0.53 [0.49, 0.57]. Out of 245 studies, 137 studies came from high-income countries, whereas only 3 studies were conducted in low-income countries. The pooled AKI prevalence from published studies in high-income countries was higher both in ICU studies (0.60; CI:0.54,0.66) and general hospitalised patients (0.28; CI:0.25,0.31). By region, the pooled AKI prevalence from published studies in North America was higher compared to other regions for both ICU only studies (0.60; CI:0.54,0.66) and studies included general hospitalised patients (0.73; CI:0.66,0.79). Lower pooled AKI prevalence was found in South Asia (ICU:0.32; CI: 0.20,0.45; general hospitalised patients: 0.23; CI:0.15,0.32). Of the 245 studies, 44 were conducted in the United States, and 28 were conducted in mainland China. The pooled AKI prevalence from published studies in the United States were higher for both ICU cohort (0.72; CI:0.65,0.79) and the general ward cohort (0.34; CI:0.30,0.38). 

Figure 1: COVID-19 general ward hospitalised patients pooled AKI prevalence by income group and region. 

Figure 2: COVID-19 ICU patients pooled AKI prevalence by income group and region. 

Conclusions:

This systematic review and meta-analysis provide an overview of COVID AKI from a global standpoint. Our study shows significant geographic and socio-economic disparities in the prevalence of COVID-associated AKI in published studies, with a higher prevalence in high-income countries, particularly North America, compared to other regions. This study is the first systematic review and meta-analysis to highlight the global disparities in the prevalence of COVID-associated AKI, further studies are needed to explain the potential reasons behind these differences.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.