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

Edmund Y.M. Chung, Suetonia C. Palmer, Patrizia Natale, Anoushka Krishnan, Tess E. Cooper, Valeria M. Saglimbene, Marinella Ruospo, Eric Au, Sumedh Jayanti, Amy Liang, Danny Jia Jie Deng, Juanita Chui, Gail Y. Higgins, Allison Tong, Germaine Wong, Armando Teixeira-Pinto, Elisabeth M. Hodson, Jonathan C. Craig, Giovanni F.M. Strippoli

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64 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)804-815
Number of pages12
JournalAmerican Journal of Kidney Diseases
Issue number6
Publication statusPublished - Dec 2021


  • chronic kidney disease (CKD)
  • cohort studies
  • Coronavirus disease 2019 (COVID-19)
  • 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


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