• Lirong Lin, Xiang Wang, Jiangwen Ren, Yan Sun, Rongjie Yu, Kailong Li, Luquan Zheng, and Jurong Yang.
• Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, Chongqing, China.
• BMJ Open. 2020 Nov 10; 10 (11): e042573.

ObjectiveTo analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19.DesignMeta-analysis.Data SourcesPubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020.Study SelectionStudies examining the following demographics and outcomes were included: patients' age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection.ResultsA total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92-4.25) and an OR of 6.07, 95% CI (2.53-14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83-15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13-13.36).ConclusionAKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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