Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis

Am J Kidney Dis. 2021 Dec;78(6):804-815. doi: 10.1053/j.ajkd.2021.07.003. Epub 2021 Aug 5.


Rationale & objective: Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD.

Study design: Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021.

Setting & study populations: People with CKD with or without COVID-19.

Selection criteria for studies: Cohort and case-control studies.

Data extraction: Incidences of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue.

Analytical approach: Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Results: 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than in those with CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) or in kidney or pancreas/kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1,000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher than in people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants).

Limitations: Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19, and potential confounders were not adjusted for in most studies.

Conclusions: The incidence of COVID-19 may be higher in people receiving maintenance dialysis than in those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas/kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.

Keywords: Coronavirus disease 2019 (COVID-19); chronic kidney disease (CKD); cohort studies; dialysis patients; end-stage kidney disease (ESKD); incidence; meta-analysis; mortality; prognosis; respiratory failure; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / therapy
  • Hospital Mortality
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Outcome and Process Assessment, Health Care
  • Renal Dialysis
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / therapy
  • SARS-CoV-2 / isolation & purification