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Desfechos de lesão renal aguda em pacientes com covid-19: revisão sistemática e metanálise

Resumo

Antecedentes:

Lesão renal aguda (LRA) é uma complicação frequente da doença do coronavírus-19 (COVID-19). Desta forma, decidimos realizar uma revisão sistemática e uma metanálise com dados da literatura para relacionar o desenvolvimento de LRA associada à COVID-19 com comorbidades, medicamentos e o impacto da ventilação mecânica.

Métodos:

Realizamos uma revisão sistemática usando a escala de Newcastle-Ottawa e uma metanálise utilizando o programa R. Estudos relevantes foram pesquisados nos bancos de dados eletrônicos PubMed, Medline e SciELO. Foram utilizados filtros de pesquisa para incluir relatos após 2020 e estudos de coorte.

Resultados:

No total, foram identificados 1166 artigos, e foram incluídos 55 artigos escritos em língua inglesa com base no risco de viés. De todos os pacientes hospitalizados por COVID-19 apresentando LRA (n = 18029) classificados como Kidney Disease Improving Global Outcomes estágios 1 a 3, aproximadamente 18% necessitaram de ventilação mecânica e 39,2% foram a óbito. Cerca de 11,3% dos pacientes necessitaram de terapia renal substitutiva (TRS) e destes, 1093 foram a óbito e 321 necessitaram de TRS contínua. O óbito é mais frequente em indivíduos com LRA [OR 6,03; IC95%: 5,73-6,74; p<0,01]. Por fim, a ventilação mecânica é um fator agravante nas condições clínicas estudadas [OR 11,01; IC95%: 10,29-11,77; p<0,01].

Conclusão:

A literatura atual indica a LRA como uma complicação importante na COVID-19. Neste contexto, observamos que comorbidades, como doença renal crônica e insuficiência cardíaca, estiveram mais relacionadas ao desenvolvimento de LRA. Além disso, a ventilação mecânica foi vista como um fator agravante neste cenário.

Descritores:
SARS-CoV-2; COVID-19; Injúria Renal Aguda; Terapia de Substituição Renal

Abstract

Background:

Acute kidney injury (AKI) is a frequent complication of coronavirus-19 disease (COVID-19). Therefore, we decided to perform a systematic review and meta-analysis with data from the literature to relate the development of COVID-19 associated-AKI with comorbidities, medications, and the impact of mechanical ventilation.

Methods:

We performed a systematic review using the Newcastle-Ottawa scale and a meta-analysis using the R program. Relevant studies were searched in the PubMed, Medline, and SciELO electronic databases. Search filters were used to include reports after 2020 and cohort studies.

Results:

In total, 1166 articles were identified and 55 English-written articles were included based on the risk of bias. Of all COVID-19-hospitalized patients presenting with AKI (n = 18029) classified as Kidney Disease Improving Global Outcomes stage 1 to 3, approximately 18% required mechanical ventilation and 39.2 % died. Around 11.3% of the patients required kidney replacement therapy (KRT) and of these, 1093 died and 321 required continuous KRT. Death is more frequent in individuals with AKI [OR 6.03, 95%CI: 5.73-6.74; p<0.01]. Finally, mechanical ventilation is an aggravating factor in the clinical conditions studied [OR 11.01, 95%CI: 10.29-11.77; p<0.01].

Conclusion:

Current literature indicates AKI as an important complication in COVID-19. In this context, we observed that comorbidities, such as chronic kidney disease and heart failure, were more related to the development of AKI. In addition, mechanical ventilation was seen as an aggravating factor in this scenario.

Keywords:
SARS-CoV-2; COVID-19; Acute Kidney Injury; Renal Replacement Therapy

Histórico

O coronavírus (CoV) faz parte de uma família patogênica de vírus RNA envelopados que podem causar infecções respiratórias graves associadas a uma elevada taxa de mortalidade11 Moitinho MS, Belasco AGS, Barbosa DA, Fonseca CD. Acute kidney injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review. Rev Bras Enferm. 2020;73(Suppl 2):e20200354. DOI: https://doi.org/10.1590/0034-7167-2020-0354
https://doi.org/10.1590/0034-7167-2020-0...
,22 Soleimani M. Acute kidney injury in SARS-CoV-2 infection: direct effect of virus on kidney proximal tubule cells. Int J Mol Sci. 2020 May;21(9):3275. DOI: https://doi.org/10.3390/ijms21093275
https://doi.org/10.3390/ijms21093275...
. Recentemente, alguns CoVs causaram epidemias e pandemias, como a síndrome respiratória aguda grave (SARS), a síndrome respiratória do Oriente Médio e, mais recentemente, o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), que causa a doença do coronavírus-19 (COVID-19).

A COVID-19 pode desencadear processos inflamatórios, tais como a liberação e o aumento de citocinas inflamatórias, que podem infiltrar-se no trato respiratório superior e nos pulmões e causar lesões, destruição do parênquima pulmonar e inflamação grave11 Moitinho MS, Belasco AGS, Barbosa DA, Fonseca CD. Acute kidney injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review. Rev Bras Enferm. 2020;73(Suppl 2):e20200354. DOI: https://doi.org/10.1590/0034-7167-2020-0354
https://doi.org/10.1590/0034-7167-2020-0...
.

Além disso, há evidências crescentes de disfunção renal em pacientes com COVID-1933 Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The novel coronavirus 2019 epidemic and kidneys. Kidney Int. 2020 May;97(5):824-8. DOI: https://doi.org/10.1016/j.kint.2020.03.001
https://doi.org/10.1016/j.kint.2020.03.0...

4 Pei G, Zhang Z, Peng J, Zhang C, Yu C, Ma Z, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020 Jun;31(6):1157-65. DOI: https://doi.org/10.1681/asn.2020030276
https://doi.org/10.1681/asn.2020030276...
-55 Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 post-mortem findings of patients with COVID-19 in China. Kidney Int. 2020 Jul;98(1):219-27. DOI: https://dx.doi.org/10.1016%2Fj.kint.2020.04.003
https://dx.doi.org/10.1016%2Fj.kint.2020...
. Embora outros mecanismos estejam sendo descobertos66 Harrison AG, Lin T, Wang P. Mechanisms of SARS-CoV-2 transmission and pathogenesis. Trends Immunol. 2020 Dec;41(12):1100-5. DOI: https://doi.org/10.1016/j.it.2020.10.004
https://doi.org/10.1016/j.it.2020.10.004...
, o pensamento atual é que os efeitos em vários órgãos são potencialmente atribuídos à ampla distribuição do receptor da enzima conversora da angiotensina 2 (ECA-2), que permite a adesão do vírus SARS-CoV-2 à célula33 Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The novel coronavirus 2019 epidemic and kidneys. Kidney Int. 2020 May;97(5):824-8. DOI: https://doi.org/10.1016/j.kint.2020.03.001
https://doi.org/10.1016/j.kint.2020.03.0...
,66 Harrison AG, Lin T, Wang P. Mechanisms of SARS-CoV-2 transmission and pathogenesis. Trends Immunol. 2020 Dec;41(12):1100-5. DOI: https://doi.org/10.1016/j.it.2020.10.004
https://doi.org/10.1016/j.it.2020.10.004...

7 Aragão DS, Cunha TS, Arita DY, Andrade MCC, Fernandes AB, Watanabe IKM, et al. Purification and characterization of angiotensin-converting enzyme 2 (ACE2) from a murine model of a mesangial cell in culture. Int J Biol Macromol. 2011 Jul;49(1):79-84. DOI: https://doi.org/10.1016/j.ijbiomac.2011.03.018
https://doi.org/10.1016/j.ijbiomac.2011....
-88 Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020 Mar;14(2):185-92. DOI: https://doi.org/10.1007/s11684-020-0754-0
https://doi.org/10.1007/s11684-020-0754-...
. Até o momento, a expressão da ECA-2 foi identificada em células do pulmão, fígado, estômago, íleo, cólon, esôfago e rim8.

O rim é um dos órgãos mais afetados pelo SARS-CoV-2 em pacientes gravemente enfermos. A lesão renal aguda (LRA) causada pela infecção por SARS-CoV-2 é comum e às vezes resulta na necessidade de terapia renal substitutiva (TRS), como necessário em outras causas de LRA99 Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012 Aug;380(9843):756-66. DOI: https://doi.org/10.1016/s0140-6736(11)61454-2
https://doi.org/10.1016/s0140-6736(11)61...
,1010 Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, et al. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med. 2020 Nov;20:290. DOI: https://doi.org/10.1186/s12890-020-01305-5
https://doi.org/10.1186/s12890-020-01305...
.

A LRA ocorre em 5 a 15% dos pacientes hospitalizados com COVID-19, e a mortalidade aumenta proporcionalmente à gravidade da lesão renal, especialmente nos estágios II e III dos critérios do KDIGO1111 Mokhtari T, Hassani F, Ghaffari N, Ebrahimi B, Yarahmadi A, Hassanzadeh G. COVID-19 and multiorgan failure: a narrative review on potential mechanisms. J Mol Histol. 2020 Oct;51(6):613-28. DOI: https://doi.org/10.1007/s10735-020-09915-3
https://doi.org/10.1007/s10735-020-09915...
,1212 Raza A, Estepa A, Chan V, Jafar MS. Acute renal failure in critically ill COVID-19 patients with a focus on the role of renal replacement therapy: a review of what we know so far. Cureus. 2020 Jun;12(6):e8429. DOI: https://doi.org/10.7759/cureus.8429
https://doi.org/10.7759/cureus.8429...
. Estudos recentes mostraram que a maioria dos pacientes internados com COVID-19 que progrediram para LRA com necessidade de TRS apresentam maior mortalidade. Isto sugere que o comprometimento da função renal contribui para o agravamento das condições clínicas e da mortalidade em pacientes com COVID-191111 Mokhtari T, Hassani F, Ghaffari N, Ebrahimi B, Yarahmadi A, Hassanzadeh G. COVID-19 and multiorgan failure: a narrative review on potential mechanisms. J Mol Histol. 2020 Oct;51(6):613-28. DOI: https://doi.org/10.1007/s10735-020-09915-3
https://doi.org/10.1007/s10735-020-09915...

12 Raza A, Estepa A, Chan V, Jafar MS. Acute renal failure in critically ill COVID-19 patients with a focus on the role of renal replacement therapy: a review of what we know so far. Cureus. 2020 Jun;12(6):e8429. DOI: https://doi.org/10.7759/cureus.8429
https://doi.org/10.7759/cureus.8429...
-1313 Dudoignon E, Moreno N, Deniau B, Coutrout M, Longer R, Amiot Q, et al. Activation of the renin-angiotensin-aldosterone system is associated with acute kidney injury in COVID-19. Anaesth Crit Care Pain Med. 2020 Aug;39(4):453-5. DOI: https://doi.org/10.1016/j.accpm.2020.06.006
https://doi.org/10.1016/j.accpm.2020.06....
.

O mecanismo de ação do vírus no sistema renal permanece incerto. É debatido se o SARS-CoV-2 interage com o sistema renina-angiotensina-aldosterona, entra na célula hospedeira para utilizar a maquinaria genética e, finalmente, resulta em replicação viral, inflamação e danos celulares1313 Dudoignon E, Moreno N, Deniau B, Coutrout M, Longer R, Amiot Q, et al. Activation of the renin-angiotensin-aldosterone system is associated with acute kidney injury in COVID-19. Anaesth Crit Care Pain Med. 2020 Aug;39(4):453-5. DOI: https://doi.org/10.1016/j.accpm.2020.06.006
https://doi.org/10.1016/j.accpm.2020.06....
,1414 Na KR, Kim HR, Ham Y, Choi DE, Lee KW, Moon JY, et al. Acute kidney injury and kidney damage in COVID-19 patients. J Korean Med Sci. 2020 Jul;35(28):e257. DOI: https://dx.doi.org/10.3346%2Fjkms.2020.35.e257
https://dx.doi.org/10.3346%2Fjkms.2020.3...
.

Apesar de diversos estudos, o mecanismo fisiopatológico exato da LRA induzida pela COVID-19 não foi completamente elucidado. Acredita-se que a LRA decorrente de necrose tubular aguda isquêmica esteja relacionada à insuficiência respiratória na funcionalidade crosstalk, que geralmente está associada ao colapso sistêmico1515 Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020 Jul;98(1):209-18. DOI: https://doi.org/10.1016/j.kint.2020.05.006
https://doi.org/10.1016/j.kint.2020.05.0...
. Além disso, pesquisadores relataram que proteinúria e hematúria estão associadas a uma elevada taxa de mortalidade em pacientes com COVID-1916.

A LRA é comum entre os pacientes com COVID-19 gravemente doentes1717 Braun F, Lütgehetmann M, Pfefferle S, Wong MN, Carsten A, Lindenmeyer MT, et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet. 2020 Aug;396(10251):597-8. DOI: https://doi.org/10.1016/s0140-6736(20)31759-1
https://doi.org/10.1016/s0140-6736(20)31...

18 Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe. 2020 Oct;1(6):e245-e53. DOI: https://doi.org/10.1016/s2666-5247(20)30115-4
https://doi.org/10.1016/s2666-5247(20)30...

19 Kudose S, Batal I, Santoriello D, Xu K, Barasch J, Peleg Y, et al. Kidney biopsy findings in patients with COVID-19. J Am Soc Nephrol. 2020 Sep;31(9):1959-68. DOI: https://doi.org/10.1681/asn.2020060802
https://doi.org/10.1681/asn.2020060802...
-2020 Pan XW, Xu D, Zhang H, Zhou W, Wang LH, Cui XG. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020 Mar;46(6):1114-6. DOI: https://doi.org/10.1007/s00134-020-06026-1
https://doi.org/10.1007/s00134-020-06026...
, dos quais 20 a 40% são admitidos em unidades de terapia intensiva (UTIs)2121 Puelles VG, Lütgehetmann M, Lindenmeyer MT, Sperhake JP, Wong MN, Allweiss L, et al. Multiorgan and renal tropism of SARS-CoV-2. N Engl J Med. 2020 Sep;383(6):590-2. DOI: https://dx.doi.org/10.1056%2FNEJMc2011400
https://dx.doi.org/10.1056%2FNEJMc201140...

22 Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020 Apr;323(20):2052-9. DOI: https://doi.org/10.1001/jama.2020.6775
https://doi.org/10.1001/jama.2020.6775...

23 Schurink B, Roos E, Radonic T, Barbe E, Bouman CSC, Boer HH, et al. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study. Lancet Microbe. 2020 Nov;1(7):e290-e9. DOI: https://doi.org/10.1016/s2666-5247(20)30144-0
https://doi.org/10.1016/s2666-5247(20)30...

24 Cheng Y, Luo R, Wang X, Wang K, Zhang N, Zhang M, et al. The incidence, risk factors, and prognosis of acute kidney injury in adult patients with coronavirus disease 2019. Clin J Am Soc Nephrol. 2020 Oct;15(10):1394-402. DOI: https://doi.org/10.2215/cjn.04650420
https://doi.org/10.2215/cjn.04650420...
-2525 Fisher M, Neugarten J, Bellin E, Yunes M, Stahl L, Johns TS, et al. AKI in hospitalized patients with and without COVID-19: a comparison study. J Am Soc Nephrol. 2020 Sep;31(9):2145-57. DOI: https://doi.org/10.1681/asn.2020040509
https://doi.org/10.1681/asn.2020040509...
. As possíveis causas de LRA induzida por COVID-19 incluem depleção de volume, inflamação, alterações hemodinâmicas, dano tubular associado à infecção viral, processos vasculares trombóticos, doenças glomerulares e rabdomiólise2626 Ronco C, Bellomo R, Ricci Z. Continuous renal replacement therapy in critically ill patients. Nephrol Dial Transplant. 2001 Jul;16 (Suppl 5):67-72. DOI: https://doi.org/10.1093/ndt/16.suppl_5.67
https://doi.org/10.1093/ndt/16.suppl_5.6...

27 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar;395(10229):1054-62. DOI: https://doi.org/10.1016/s0140-6736(20)30566-3
https://doi.org/10.1016/s0140-6736(20)30...
-2828 Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. J Am Soc Nephrol. 2020 Jul;31(7):1380-3. DOI: https://doi.org/10.1681/asn.2020040419
https://doi.org/10.1681/asn.2020040419...
. Além disso, pacientes com LRA com COVID-19 foram mais propensos a demandar TRS do que pacientes com LRA sem COVID-191919 Kudose S, Batal I, Santoriello D, Xu K, Barasch J, Peleg Y, et al. Kidney biopsy findings in patients with COVID-19. J Am Soc Nephrol. 2020 Sep;31(9):1959-68. DOI: https://doi.org/10.1681/asn.2020060802
https://doi.org/10.1681/asn.2020060802...
,2626 Ronco C, Bellomo R, Ricci Z. Continuous renal replacement therapy in critically ill patients. Nephrol Dial Transplant. 2001 Jul;16 (Suppl 5):67-72. DOI: https://doi.org/10.1093/ndt/16.suppl_5.67
https://doi.org/10.1093/ndt/16.suppl_5.6...
.

O envolvimento renal, incluindo anormalidades urinárias e alterações na função renal, é observado em aproximadamente 75% dos pacientes com COVID-19. A LRA atua como um fator de risco para a mortalidade hospitalar nestes pacientes22 Soleimani M. Acute kidney injury in SARS-CoV-2 infection: direct effect of virus on kidney proximal tubule cells. Int J Mol Sci. 2020 May;21(9):3275. DOI: https://doi.org/10.3390/ijms21093275
https://doi.org/10.3390/ijms21093275...
,2828 Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. J Am Soc Nephrol. 2020 Jul;31(7):1380-3. DOI: https://doi.org/10.1681/asn.2020040419
https://doi.org/10.1681/asn.2020040419...

29 Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 May;97(5):829-38. DOI: https://dx.doi.org/10.1016%2Fj.kint.2020.03.005
https://dx.doi.org/10.1016%2Fj.kint.2020...

30 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb;395(10223):497-506. DOI: https://doi.org/10.1016/s0140-6736(20)30183-5
https://doi.org/10.1016/s0140-6736(20)30...

31 Russo E, Esposito P, Taramasso L, Magnasco L, Saio M, Briano F, et al. Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy. J Nephrol. 2021 Oct;34(1):173-83. DOI: https://doi.org/10.1007/s40620-020-00875-1
https://doi.org/10.1007/s40620-020-00875...
-3232 Khusid JA, Becerra AZ, Gallante B, Sadiq AS, Atallah WM, Dabani KK, et al. Cancer, mortality, and acute kidney injury among hospitalized patients with SARS-CoV-2 infection. Asian Pac J Cancer Prev. 2021;22(2):517-22. DOI: https://doi.org/10.31557/APJCP.2021.22.2.517
https://doi.org/10.31557/APJCP.2021.22.2...
. Portanto, esta revisão da literatura examinou a evolução de pacientes com COVID-19 e a associação entre a doença e a LRA. Especificamente, este estudo teve como objetivo identificar o número de pacientes infectados por SARS-CoV-2 que desenvolveram LRA. Além disso, procuramos esclarecer o número de pacientes com LRA relacionada à COVID-19 que necessitam de TRS e o número de óbitos. Por fim, visamos identificar associações de comorbidades preexistentes, medicamentos e ventilação mecânica em pacientes com LRA relacionada à COVID-19.

Métodos

O método de revisão sistemática foi utilizado para analisar estudos que sugerissem uma relação entre o desenvolvimento de LRA no contexto da COVID-19. Como os desfechos dos artigos incluídos na revisão são semelhantes, foi realizada uma metanálise, proporcionando maior confiabilidade aos resultados obtidos a partir dos dados coletados.

Realizamos uma busca sensível nas plataformas Pubmed, MEDLINE e Scielo usando os termos MeSH (COVID-19, Lesão Renal Aguda, Terapia Renal Substitutiva) e seus sinônimos, combinados com o filtro de consultas para estudos observacionais, de coorte, séries de casos e de corte transversal (Apêndice 1). Foram incluídos artigos com as palavras-chave MeSH presentes no título e com o tipo de estudo adequado (coorte). Foram excluídos artigos publicados antes de 2020, metanálises e artigos de revisão. Com base nestes critérios, foram identificados 60 artigos, todos escritos na língua inglesa.

O risco de viés dos artigos analisados foi determinado utilizando a ferramenta Newcastle-Ottawa, cuja principal função é avaliar a qualidade de estudos não randomizados (coorte). O método utilizado consiste na análise de seleção, comparabilidade e desfecho. Após classificar todos os artigos de acordo com o risco de viés, aqueles com risco indefinido (4 artigos) ou de baixa qualidade (1 artigo) foram removidos do estudo, totalizando 55 artigos que foram efetivamente analisados.

A metanálise foi baseada no cálculo de risco relativo (RR), odds ratio (OR) e intervalo de confiança de 95% usando o programa R para determinar se houve influência da LRA nos óbitos e, se necessário, comparar os óbitos de indivíduos com e sem lesão renal. Além disso, procuramos avaliar por meio de estatísticas se a ventilação mecânica teve efeito sobre os indivíduos que desenvolveram LRA durante a internação. Apenas 36 artigos trouxeram estatísticas conclusivas relacionadas à LRA e ao número de óbitos, e 20 artigos avaliaram a associação entre ventilação mecânica e LRA.

De acordo com a resolução 510/20163333 Resolution No. 510, of April 7, 2016 (BR). Provides for the rules applicable to research in the Human and Social Sciences [Internet]. Official Gazette of the Federative Republic of Brazil, Brasília, DF; 24 May 2016; [access in 2016 Oct 10]; 98: Seção 2: 44-6. Available from: http://bit.ly/2fmnKeD
http://bit.ly/2fmnKeD...
, do CNS, pesquisas realizadas exclusivamente com textos científicos para revisão de literatura científica não são registradas nem avaliadas pelo sistema de comitê de ética (CEP/CONEP). Assim, o presente estudo não demandou aprovação e processamento locais.

Resultados

No total, 1166 artigos foram selecionados por título e resumo, mas apenas 133 preencheram os critérios de inclusão e foram revisados. Após a revisão, foram excluídos 78 artigos (Figura 1).

Figura 1
Resumo das evidências, pesquisa e seleção.

Os resultados serão apresentados com base nos dados coletados dos artigos avaliados pelo risco de viés e, em seguida, pelos resultados estatísticos.

Com relação aos resultados da Escala de Avaliação de Qualidade Newcastle-Ottawa, a maioria dos artigos (39) alcançou a pontuação máxima, ou seja, uma estrela em cada um dos seguintes itens: representatividade da coorte exposta, seleção da coorte não exposta, verificação da exposição e demonstração de que o desfecho de interesse não estava presente no início do estudo. Parte dos artigos (11) recebeu 3 estrelas neste quesito, e 5 artigos não pontuaram na representatividade da coorte exposta, outros 5 não pontuaram na seleção da coorte não exposta, e 1 artigo não pontuou na demonstração de que o desfecho de interesse não estava presente no início. Nenhum dos artigos selecionados teve pontuação inferior a 3 estrelas (Tabelas 1 e 2).

Tabela 1
Informações gerais1010 Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, et al. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med. 2020 Nov;20:290. DOI: https://doi.org/10.1186/s12890-020-01305-5
https://doi.org/10.1186/s12890-020-01305...
,1414 Na KR, Kim HR, Ham Y, Choi DE, Lee KW, Moon JY, et al. Acute kidney injury and kidney damage in COVID-19 patients. J Korean Med Sci. 2020 Jul;35(28):e257. DOI: https://dx.doi.org/10.3346%2Fjkms.2020.35.e257
https://dx.doi.org/10.3346%2Fjkms.2020.3...
,1515 Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020 Jul;98(1):209-18. DOI: https://doi.org/10.1016/j.kint.2020.05.006
https://doi.org/10.1016/j.kint.2020.05.0...
,1717 Braun F, Lütgehetmann M, Pfefferle S, Wong MN, Carsten A, Lindenmeyer MT, et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet. 2020 Aug;396(10251):597-8. DOI: https://doi.org/10.1016/s0140-6736(20)31759-1
https://doi.org/10.1016/s0140-6736(20)31...
,2424 Cheng Y, Luo R, Wang X, Wang K, Zhang N, Zhang M, et al. The incidence, risk factors, and prognosis of acute kidney injury in adult patients with coronavirus disease 2019. Clin J Am Soc Nephrol. 2020 Oct;15(10):1394-402. DOI: https://doi.org/10.2215/cjn.04650420
https://doi.org/10.2215/cjn.04650420...
,2525 Fisher M, Neugarten J, Bellin E, Yunes M, Stahl L, Johns TS, et al. AKI in hospitalized patients with and without COVID-19: a comparison study. J Am Soc Nephrol. 2020 Sep;31(9):2145-57. DOI: https://doi.org/10.1681/asn.2020040509
https://doi.org/10.1681/asn.2020040509...
,2929 Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 May;97(5):829-38. DOI: https://dx.doi.org/10.1016%2Fj.kint.2020.03.005
https://dx.doi.org/10.1016%2Fj.kint.2020...
,3131 Russo E, Esposito P, Taramasso L, Magnasco L, Saio M, Briano F, et al. Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy. J Nephrol. 2021 Oct;34(1):173-83. DOI: https://doi.org/10.1007/s40620-020-00875-1
https://doi.org/10.1007/s40620-020-00875...
,3232 Khusid JA, Becerra AZ, Gallante B, Sadiq AS, Atallah WM, Dabani KK, et al. Cancer, mortality, and acute kidney injury among hospitalized patients with SARS-CoV-2 infection. Asian Pac J Cancer Prev. 2021;22(2):517-22. DOI: https://doi.org/10.31557/APJCP.2021.22.2.517
https://doi.org/10.31557/APJCP.2021.22.2...
,3434 Fominskiy EV, Scandroglio AM, Monti G, et al. Prevalence, Characteristics, Risk Factors, and Outcomes of Invasively Ventilated COVID-19 Patients with Acute Kidney Injury and Renal Replacement Therapy. Blood Purif. 2021;50(1):102-109. PMID: 32659757; https://doi.org/10.1159/000508657
https://doi.org/10.1159/000508657...

35 Dai Y, Liu Z, Du X, et al. Acute Kidney Injury in Hospitalized Patients Infected with COVID-19 from Wuhan, China: A Retrospective Study. Biomed Res Int. 2021;2021:6655185. Published 2021 Jan 11. PMID: 33506027; https://doi.org/10.1155/2021/6655185
https://doi.org/10.1155/2021/6655185...

36 Zheng X, Yang H, Li X, et al. Prevalence of Kidney Injury and Associations with Critical Illness and Death in Patients with COVID-19. Clin J Am Soc Nephrol. 2020;15(11):1549-1556. PMID: 32943396; https://doi.org/10.2215/CJN.04780420
https://doi.org/10.2215/CJN.04780420...

37 Trabulus S, Karaca C, Balkan II, et al. Kidney function on admission predicts in-hospital mortality in COVID-19. PLoS One. 2020;15(9):e0238680. Published 2020 Sep 3. PMID: 32881976; https://doi.org/10.1371/journal.pone.0238680
https://doi.org/10.1371/journal.pone.023...
-3838 Kolhe NV, Fluck RJ, Selby NM, Taal MW. Acute kidney injury associated with COVID-19: A retrospective cohort study. PLoS Med. 2020;17(10):e1003406. Published 2020 Oct 30. PMID: 33125416; https://doi.org/10.1371/journal.pmed.1003406
https://doi.org/10.1371/journal.pmed.100...
,4040 Wang X, Chen X, Tang F, et al. Be aware of acute kidney injury in critically ill children with COVID-19. Pediatr Nephrol. 2021;36(1):163-169. PMID: 32844290; https://doi.org/10.1007/s00467-020-04715-z
https://doi.org/10.1007/s00467-020-04715...
,4242 Cui X, Yu X, Wu X, et al. Acute Kidney Injury in Patients with the Coronavirus Disease 2019: A Multicenter Study. Kidney Blood Press Res. 2020;45(4):612-622. PMID: 32712607; https://doi.org/10.1159/000509517
https://doi.org/10.1159/000509517...

43 Li Q, Zhang T, Li F, et al. Acute Kidney Injury Can Predict In-Hospital Mortality in Elderly Patients with COVID-19 in the ICU: A Single-Center Study. Clin Interv Aging. 2020;15:2095-2107. PMID: 33204075; https://doi.org/10.2147/cia.s273720
https://doi.org/10.2147/cia.s273720...

44 Husain-Syed F, Wilhelm J, Kassoumeh S, et al. Acute kidney injury and urinary biomarkers in hospitalized patients with coronavirus disease-2019. Nephrol Dial Transplant. 2020;35(7):1271-1274. PMID: 32691068; https://doi.org/10.1093/ndt/gfaa162
https://doi.org/10.1093/ndt/gfaa162...

45 Chan L, Chaudhary K, Saha A, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151-160. PMID: 32883700; https://doi.org/10.1681/asn.2020050615
https://doi.org/10.1681/asn.2020050615...

46 Nalesso F, Garzotto F, Cattarin L, et al. A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19. J Clin Med. 2020;9(5):1529. PMID: 32438617; https://doi.org/10.3390/jcm9051529
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47 Yildirim C, Ozger HS, Yasar E, et al. Early predictors of acute kidney injury in COVID-19 patients. Nephrology (Carlton). 2021;26(6):513-521. PMID: 33502771; https://doi.org/10.1111/nep.13856
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,5050 Zahid U, Ramachandran P, Spitalewitz S, et al. Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications. Am J Nephrol. 2020;51(10):786-796. PMID: 33011717; https://doi.org/10.1159/000511160
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51 Hamilton P, Hanumapura P, Castelino L, et al. Characteristics and outcomes of hospitalized patients with acute kidney injury and COVID-19. PLoS One. 2020;15(11):e0241544. PMID: 33141867; https://doi.org/10.1371/journal.pone.0241544
https://doi.org/10.1371/journal.pone.024...

52 Costa RLD, Sória TC, Salles EF, et al. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality [published online ahead of print, 2021 Feb 10]. J Bras Nefrol. 2021; S0101-28002021005014301. PMID: 33570081; https://doi.org/10.1590/2175-8239-jbn-2020-0144
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53 Gupta S, Coca SG, Chan L, et al. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):161-176. PMID: 33067383; https://doi.org/10.1681/asn.2020060897
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54 Xu J, Xie J, Du B, Tong Z, Qiu H, Bagshaw SM. Clinical Characteristics and Outcomes of Patients With Severe COVID-19 Induced Acute Kidney Injury. J Intensive Care Med. 2021;36(3):319-326. PMID: 33267722; https://doi.org/10.1177/0885066620970858
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55 Khalili S, Sabaghian T, Sedaghat M, Soroureddin Z, Askari E, Khalili N. Prevalence, Risk Factors and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized for COVID-19: A Comparative Study between Diabetic and Nondiabetic Patients. J Diabetes Res. 2021; 2021:6666086. PMID: 33506050; https://doi.org/10.1155/2021/6666086
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56 Charytan DM, Parnia S, Khatri M, et al. Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City. Kidney Int Rep. 2021;6(4):916-927. PMID: 33558853; https://doi.org/10.1016/j.ekir.2021.01.036
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57 Lowe R, Ferrari M, Nasim-Mohi M, et al. Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single-center cohort study. BMC Nephrol. 2021;22(1):92. PMID: 33722189; https://doi.org/10.1186/s12882-021-02296-z
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58 Piñeiro GJ, Molina-Andújar A, Hermida E, et al. Severe acute kidney injury in critically ill COVID-19 patients. J Nephrol. 2021;34(2):285-293. PMID: 33387345; https://doi.org/10.1007/s40620-020-00918-7
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59 Murt A, Dincer MT, Karaca C, et al. Acute Kidney Injuries in different stages of COVID-19: An analysis on patients without prior kidney disease. Research Square; 2021. https://doi.org/10.21203/rs.3.rs-105205/v5
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60 Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19. Clin J Am Soc Nephrol. 2020;16(1):14-25. PMID: 33199414; https://doi.org/10.2215/cjn.09610620
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61 Hansrivijit P, Gadhiya KP, Gangireddy M, Goldman JD. Risk Factors, Clinical Characteristics, and Prognosis of Acute Kidney Injury in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Medicines (Basel). 2021;8(1):4. PMID: 33430296; https://doi.org/10.3390/medicines8010004
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62 Zamoner W, Santos CADS, Magalhães LE, de Oliveira PGS, Balbi AL, Ponce D. Acute Kidney Injury in COVID-19: 90 Days of the Pandemic in a Brazilian Public Hospital. Front Med (Lausanne). 2021; 8:622577. PMID: 33634152; https://doi.org/10.3389/fmed.2021.622577
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63 Yan Q, Zuo P, Cheng L, et al. Acute Kidney Injury Is Associated With In-hospital Mortality in Older Patients With COVID-19. J Gerontol A Biol Sci Med Sci. 2021;76(3):456-462. PMID: 32766817; https://doi.org/10.1093/gerona/glaa181
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64 Diebold M, Schaub S, Landmann E, Steiger J, Dickenmann M. Acute kidney injury in patients with COVID-19: a retrospective cohort study from Switzerland. Swiss Med Wkly. 2021;151:w20482. PMID: 33706383; https://doi.org/10.4414/smw.2021.20482
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65 Tarragón B, Valdenebro M, Serrano ML, et al. Acute kidney failure in patients admitted due to COVID-19. Fracaso renal agudo en pacientes hospitalizados por COVID-19. Nefrologia (Engl Ed). 2021;41(1):34-40. PMID: 33162225; https://doi.org/10.1016/j.nefro.2020.08.005
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66 Moledina DG, Simonov M, Yamamoto Y, et al. The Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study. Am J Kidney Dis. 2021;77(4):490-499.e1. h PMID: 33422598; https://dx.doi.org/10.1053%2Fj.ajkd.2020.12.007
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67 Xia P, Wen Y, Duan Y, et al. Clinicopathological Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 with Prolonged Disease Course: A Retrospective Cohort. J Am Soc Nephrol. 2020;31(9):2205-2221. PMID: 32826326; https://doi.org/10.1681/asn.2020040426
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68 Casas-Aparicio GA, León-Rodríguez I, Alvarado-de la Barrera C, et al. Acute kidney injury in patients with severe COVID-19 in Mexico. PLoS One. 2021;16(2):e0246595. PMID: 33556150; https://doi.org/10.1371/journal.pone.0246595
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69 Luther T, Bülow-Anderberg S, Larsson A, et al. COVID-19 patients in intensive care develop oliguric acute kidney injury predominantly. Acta Anaesthesiol Scand. 2021;65(3):364-372. PMID: 33190222; https://doi.org/10.1111/aas.13746
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70 Xu H, Garcia-Ptacek S, Annetorp M, et al. Acute kidney injury and mortality risk in older adults with COVID-19. J Nephrol. 2021;34(2):295-304. PMID: 33751497; https://doi.org/10.1007/s40620-021-01022-0
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71 Xiao G, Hu H, Wu F, et al. Nan Fang Yi Ke Da Xue Xue Bao. Acute kidney injury in patients hospitalized with COVID-19 in Wuhan, China: a single-center retrospective observational study. J South Med Univ. 2021;41(2):157-163. PMID: 33624587; https://doi.org/10.12122/j.issn.1673-4254.2021.02.01
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72 Martínez-Rueda AJ, Álvarez RD, Méndez-Pérez RA, et al. Community- and Hospital-Acquired Acute Kidney Injury in COVID-19: Different Phenotypes and Dismal Prognosis [published online ahead of print, 2021 Mar 19]. Blood Purif. 2021;1-11. PMID: 33744901; https://doi.org/10.1159/000513948
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73 Basalely A, Gurusinghe S, Schneider J, et al. Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19. Kidney Int. 2021;100(1):138-145. PMID: 33675848; https://doi.org/10.1016/j.kint.2021.02.026
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74 Almeida DC, Franco MDCP, Dos Santos DRP, et al. Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients. PLoS One. 2021;16(5):e0251048. PMID: 34033655; https://doi.org/10.1371/journal.pone.0251048
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75 Doher MP, Torres de Carvalho FR, Scherer PF, et al. Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil. Blood Purif;50(4-5):520-530. 2021 https://doi.org/10.1159/000513425 PMID: 33341806
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76 Kanbay, M., Medetalibeyoglu, A., Kanbay, A., Cevik, E., Tanriover, C., Baygul, A., Şenkal, N., Konyaoglu, H., Akpinar, T. S., Kose, M., Covic, A., & Tukek, T. (2021). Acute kidney injury in hospitalized COVID-19 patients. International urology and nephrology, 1-8. Advance online publication. https://doi.org/10.1007/s11255-021-02972-x PMID: 34410587
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77 Strohbehn, I. A., Zhao, S., Seethapathy, H., Lee, M., Rusibamayila, N., Allegretti, A. S., Parada, X. V., Sise, M. E. Acute kidney injury incidence, recovery, and long-term kidney outcomes among hospitalized patients with COVID-19 and influenza. Kidney International Reports, 6(10), 2565-2574. 2021. https://doi.org/10.1016/j.ekir.2021.07.008 PMID: 34307971
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78 Alfano, G., Ferrari, A., Fontana, F., Mori, G., Magistroni, R., Meschiari, M., Franceschini, E., Menozzi, M., Cuomo, G., Orlando, G., Santoro, A., Digaetano, M., Puzzolante, C., Carli, F., Bedini, A., Milic, J., Coloretti, I., Raggi, P., Mussini, C., Girardis, M., … Modena Covid-19 Working Group (MoCo19) (2021). Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19. Clinical and experimental nephrology, 25(11), 1203-1214. https://doi.org/10.1007/s10157-021-02092-x PMID: 34196877
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-7979 Sullivan, M. K., Lees, J. S., Drake, T. M., Docherty, A. B., Oates, G., Hardwick, H. E., Russell, C. D., Merson, L., Dunning, J., Nguyen-Van-Tam, J. S., Openshaw, P., Harrison, E. M., Baillie, J. K., & ISARIC4C Investigators (2021). Acute kidney injury in patients hospitalised with COVID-19 from the ISARIC WHO CCP-UK Study: a prospective, multicentre cohort study. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, gfab303. Advance online publication. https://doi.org/10.1093/ndt/gfab303 PMID: 34661677
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Tabela 2
Informações gerais relacionadas ao risco de viés

No item sobre comparabilidade, os artigos foram classificados com base na quantidade de informações disponíveis para análise de dados e resultados. Neste sentido, 26 artigos receberam um total de 2 estrelas porque incluíam dados de pacientes sobre idade, sexo, estágio de LRA, uso de ventilação mecânica, comorbidades e TRS. Vinte e quatro artigos obtiveram apenas uma estrela por apresentarem idade, sexo e estágio de LRA, e pelo menos um dos 3 itens subsequentes (Tabelas 1 e 2).

Por fim, a maioria dos artigos (47) teve pontuação máxima para os desfechos. Apenas 3 artigos foram classificados com 2 estrelas, e em todos esses artigos o acompanhamento não foi longo o suficiente para que os resultados ocorressem (Tabelas 1 e 2).

A Tabela 3 apresenta o número total de pacientes internados por COVID-19; aproximadamente 31% apresentaram LRA em algum momento durante o período de internação. Os pacientes de COVID-19 com LRA foram subdivididos em estágios com base em sua condição renal (Figura 2). O estágio 1 foi o mais comum, seguido pelo estágio 3. O estágio 2 apresentou o menor número de pacientes sem distribuição proporcional de gravidade da LRA de acordo com os critérios do KDIGO (Kidney Diseases Improve Global Outcomes).

Tabela 3
Classificação do risco de viés

Figura 2
Comorbidades em pacientes com COVID-19 associada à lesão renal aguda1010 Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, et al. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med. 2020 Nov;20:290. DOI: https://doi.org/10.1186/s12890-020-01305-5
https://doi.org/10.1186/s12890-020-01305...
,1414 Na KR, Kim HR, Ham Y, Choi DE, Lee KW, Moon JY, et al. Acute kidney injury and kidney damage in COVID-19 patients. J Korean Med Sci. 2020 Jul;35(28):e257. DOI: https://dx.doi.org/10.3346%2Fjkms.2020.35.e257
https://dx.doi.org/10.3346%2Fjkms.2020.3...
,1515 Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020 Jul;98(1):209-18. DOI: https://doi.org/10.1016/j.kint.2020.05.006
https://doi.org/10.1016/j.kint.2020.05.0...
,1717 Braun F, Lütgehetmann M, Pfefferle S, Wong MN, Carsten A, Lindenmeyer MT, et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet. 2020 Aug;396(10251):597-8. DOI: https://doi.org/10.1016/s0140-6736(20)31759-1
https://doi.org/10.1016/s0140-6736(20)31...
,2424 Cheng Y, Luo R, Wang X, Wang K, Zhang N, Zhang M, et al. The incidence, risk factors, and prognosis of acute kidney injury in adult patients with coronavirus disease 2019. Clin J Am Soc Nephrol. 2020 Oct;15(10):1394-402. DOI: https://doi.org/10.2215/cjn.04650420
https://doi.org/10.2215/cjn.04650420...
,2525 Fisher M, Neugarten J, Bellin E, Yunes M, Stahl L, Johns TS, et al. AKI in hospitalized patients with and without COVID-19: a comparison study. J Am Soc Nephrol. 2020 Sep;31(9):2145-57. DOI: https://doi.org/10.1681/asn.2020040509
https://doi.org/10.1681/asn.2020040509...
,2929 Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 May;97(5):829-38. DOI: https://dx.doi.org/10.1016%2Fj.kint.2020.03.005
https://dx.doi.org/10.1016%2Fj.kint.2020...
,3131 Russo E, Esposito P, Taramasso L, Magnasco L, Saio M, Briano F, et al. Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy. J Nephrol. 2021 Oct;34(1):173-83. DOI: https://doi.org/10.1007/s40620-020-00875-1
https://doi.org/10.1007/s40620-020-00875...
,3232 Khusid JA, Becerra AZ, Gallante B, Sadiq AS, Atallah WM, Dabani KK, et al. Cancer, mortality, and acute kidney injury among hospitalized patients with SARS-CoV-2 infection. Asian Pac J Cancer Prev. 2021;22(2):517-22. DOI: https://doi.org/10.31557/APJCP.2021.22.2.517
https://doi.org/10.31557/APJCP.2021.22.2...
,3434 Fominskiy EV, Scandroglio AM, Monti G, et al. Prevalence, Characteristics, Risk Factors, and Outcomes of Invasively Ventilated COVID-19 Patients with Acute Kidney Injury and Renal Replacement Therapy. Blood Purif. 2021;50(1):102-109. PMID: 32659757; https://doi.org/10.1159/000508657
https://doi.org/10.1159/000508657...

35 Dai Y, Liu Z, Du X, et al. Acute Kidney Injury in Hospitalized Patients Infected with COVID-19 from Wuhan, China: A Retrospective Study. Biomed Res Int. 2021;2021:6655185. Published 2021 Jan 11. PMID: 33506027; https://doi.org/10.1155/2021/6655185
https://doi.org/10.1155/2021/6655185...

36 Zheng X, Yang H, Li X, et al. Prevalence of Kidney Injury and Associations with Critical Illness and Death in Patients with COVID-19. Clin J Am Soc Nephrol. 2020;15(11):1549-1556. PMID: 32943396; https://doi.org/10.2215/CJN.04780420
https://doi.org/10.2215/CJN.04780420...

37 Trabulus S, Karaca C, Balkan II, et al. Kidney function on admission predicts in-hospital mortality in COVID-19. PLoS One. 2020;15(9):e0238680. Published 2020 Sep 3. PMID: 32881976; https://doi.org/10.1371/journal.pone.0238680
https://doi.org/10.1371/journal.pone.023...
-3838 Kolhe NV, Fluck RJ, Selby NM, Taal MW. Acute kidney injury associated with COVID-19: A retrospective cohort study. PLoS Med. 2020;17(10):e1003406. Published 2020 Oct 30. PMID: 33125416; https://doi.org/10.1371/journal.pmed.1003406
https://doi.org/10.1371/journal.pmed.100...
,4040 Wang X, Chen X, Tang F, et al. Be aware of acute kidney injury in critically ill children with COVID-19. Pediatr Nephrol. 2021;36(1):163-169. PMID: 32844290; https://doi.org/10.1007/s00467-020-04715-z
https://doi.org/10.1007/s00467-020-04715...
,4242 Cui X, Yu X, Wu X, et al. Acute Kidney Injury in Patients with the Coronavirus Disease 2019: A Multicenter Study. Kidney Blood Press Res. 2020;45(4):612-622. PMID: 32712607; https://doi.org/10.1159/000509517
https://doi.org/10.1159/000509517...

43 Li Q, Zhang T, Li F, et al. Acute Kidney Injury Can Predict In-Hospital Mortality in Elderly Patients with COVID-19 in the ICU: A Single-Center Study. Clin Interv Aging. 2020;15:2095-2107. PMID: 33204075; https://doi.org/10.2147/cia.s273720
https://doi.org/10.2147/cia.s273720...

44 Husain-Syed F, Wilhelm J, Kassoumeh S, et al. Acute kidney injury and urinary biomarkers in hospitalized patients with coronavirus disease-2019. Nephrol Dial Transplant. 2020;35(7):1271-1274. PMID: 32691068; https://doi.org/10.1093/ndt/gfaa162
https://doi.org/10.1093/ndt/gfaa162...

45 Chan L, Chaudhary K, Saha A, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151-160. PMID: 32883700; https://doi.org/10.1681/asn.2020050615
https://doi.org/10.1681/asn.2020050615...

46 Nalesso F, Garzotto F, Cattarin L, et al. A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19. J Clin Med. 2020;9(5):1529. PMID: 32438617; https://doi.org/10.3390/jcm9051529
https://doi.org/10.3390/jcm9051529...

47 Yildirim C, Ozger HS, Yasar E, et al. Early predictors of acute kidney injury in COVID-19 patients. Nephrology (Carlton). 2021;26(6):513-521. PMID: 33502771; https://doi.org/10.1111/nep.13856
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-4848 Ng JH, Hirsch JS, Hazzan A, et al. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis. 2021;77(2):204-215.e1. PMID: 32961245; https://doi.org/10.1053/j.ajkd.2020.09.002
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,5050 Zahid U, Ramachandran P, Spitalewitz S, et al. Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications. Am J Nephrol. 2020;51(10):786-796. PMID: 33011717; https://doi.org/10.1159/000511160
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51 Hamilton P, Hanumapura P, Castelino L, et al. Characteristics and outcomes of hospitalized patients with acute kidney injury and COVID-19. PLoS One. 2020;15(11):e0241544. PMID: 33141867; https://doi.org/10.1371/journal.pone.0241544
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52 Costa RLD, Sória TC, Salles EF, et al. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality [published online ahead of print, 2021 Feb 10]. J Bras Nefrol. 2021; S0101-28002021005014301. PMID: 33570081; https://doi.org/10.1590/2175-8239-jbn-2020-0144
https://doi.org/10.1590/2175-8239-jbn-20...

53 Gupta S, Coca SG, Chan L, et al. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):161-176. PMID: 33067383; https://doi.org/10.1681/asn.2020060897
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54 Xu J, Xie J, Du B, Tong Z, Qiu H, Bagshaw SM. Clinical Characteristics and Outcomes of Patients With Severe COVID-19 Induced Acute Kidney Injury. J Intensive Care Med. 2021;36(3):319-326. PMID: 33267722; https://doi.org/10.1177/0885066620970858
https://doi.org/10.1177/0885066620970858...

55 Khalili S, Sabaghian T, Sedaghat M, Soroureddin Z, Askari E, Khalili N. Prevalence, Risk Factors and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized for COVID-19: A Comparative Study between Diabetic and Nondiabetic Patients. J Diabetes Res. 2021; 2021:6666086. PMID: 33506050; https://doi.org/10.1155/2021/6666086
https://doi.org/10.1155/2021/6666086...

56 Charytan DM, Parnia S, Khatri M, et al. Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City. Kidney Int Rep. 2021;6(4):916-927. PMID: 33558853; https://doi.org/10.1016/j.ekir.2021.01.036
https://doi.org/10.1016/j.ekir.2021.01.0...

57 Lowe R, Ferrari M, Nasim-Mohi M, et al. Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single-center cohort study. BMC Nephrol. 2021;22(1):92. PMID: 33722189; https://doi.org/10.1186/s12882-021-02296-z
https://doi.org/10.1186/s12882-021-02296...

58 Piñeiro GJ, Molina-Andújar A, Hermida E, et al. Severe acute kidney injury in critically ill COVID-19 patients. J Nephrol. 2021;34(2):285-293. PMID: 33387345; https://doi.org/10.1007/s40620-020-00918-7
https://doi.org/10.1007/s40620-020-00918...

59 Murt A, Dincer MT, Karaca C, et al. Acute Kidney Injuries in different stages of COVID-19: An analysis on patients without prior kidney disease. Research Square; 2021. https://doi.org/10.21203/rs.3.rs-105205/v5
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60 Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19. Clin J Am Soc Nephrol. 2020;16(1):14-25. PMID: 33199414; https://doi.org/10.2215/cjn.09610620
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61 Hansrivijit P, Gadhiya KP, Gangireddy M, Goldman JD. Risk Factors, Clinical Characteristics, and Prognosis of Acute Kidney Injury in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Medicines (Basel). 2021;8(1):4. PMID: 33430296; https://doi.org/10.3390/medicines8010004
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62 Zamoner W, Santos CADS, Magalhães LE, de Oliveira PGS, Balbi AL, Ponce D. Acute Kidney Injury in COVID-19: 90 Days of the Pandemic in a Brazilian Public Hospital. Front Med (Lausanne). 2021; 8:622577. PMID: 33634152; https://doi.org/10.3389/fmed.2021.622577
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63 Yan Q, Zuo P, Cheng L, et al. Acute Kidney Injury Is Associated With In-hospital Mortality in Older Patients With COVID-19. J Gerontol A Biol Sci Med Sci. 2021;76(3):456-462. PMID: 32766817; https://doi.org/10.1093/gerona/glaa181
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64 Diebold M, Schaub S, Landmann E, Steiger J, Dickenmann M. Acute kidney injury in patients with COVID-19: a retrospective cohort study from Switzerland. Swiss Med Wkly. 2021;151:w20482. PMID: 33706383; https://doi.org/10.4414/smw.2021.20482
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65 Tarragón B, Valdenebro M, Serrano ML, et al. Acute kidney failure in patients admitted due to COVID-19. Fracaso renal agudo en pacientes hospitalizados por COVID-19. Nefrologia (Engl Ed). 2021;41(1):34-40. PMID: 33162225; https://doi.org/10.1016/j.nefro.2020.08.005
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66 Moledina DG, Simonov M, Yamamoto Y, et al. The Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study. Am J Kidney Dis. 2021;77(4):490-499.e1. h PMID: 33422598; https://dx.doi.org/10.1053%2Fj.ajkd.2020.12.007
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67 Xia P, Wen Y, Duan Y, et al. Clinicopathological Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 with Prolonged Disease Course: A Retrospective Cohort. J Am Soc Nephrol. 2020;31(9):2205-2221. PMID: 32826326; https://doi.org/10.1681/asn.2020040426
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68 Casas-Aparicio GA, León-Rodríguez I, Alvarado-de la Barrera C, et al. Acute kidney injury in patients with severe COVID-19 in Mexico. PLoS One. 2021;16(2):e0246595. PMID: 33556150; https://doi.org/10.1371/journal.pone.0246595
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69 Luther T, Bülow-Anderberg S, Larsson A, et al. COVID-19 patients in intensive care develop oliguric acute kidney injury predominantly. Acta Anaesthesiol Scand. 2021;65(3):364-372. PMID: 33190222; https://doi.org/10.1111/aas.13746
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70 Xu H, Garcia-Ptacek S, Annetorp M, et al. Acute kidney injury and mortality risk in older adults with COVID-19. J Nephrol. 2021;34(2):295-304. PMID: 33751497; https://doi.org/10.1007/s40620-021-01022-0
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71 Xiao G, Hu H, Wu F, et al. Nan Fang Yi Ke Da Xue Xue Bao. Acute kidney injury in patients hospitalized with COVID-19 in Wuhan, China: a single-center retrospective observational study. J South Med Univ. 2021;41(2):157-163. PMID: 33624587; https://doi.org/10.12122/j.issn.1673-4254.2021.02.01
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72 Martínez-Rueda AJ, Álvarez RD, Méndez-Pérez RA, et al. Community- and Hospital-Acquired Acute Kidney Injury in COVID-19: Different Phenotypes and Dismal Prognosis [published online ahead of print, 2021 Mar 19]. Blood Purif. 2021;1-11. PMID: 33744901; https://doi.org/10.1159/000513948
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73 Basalely A, Gurusinghe S, Schneider J, et al. Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19. Kidney Int. 2021;100(1):138-145. PMID: 33675848; https://doi.org/10.1016/j.kint.2021.02.026
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74 Almeida DC, Franco MDCP, Dos Santos DRP, et al. Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients. PLoS One. 2021;16(5):e0251048. PMID: 34033655; https://doi.org/10.1371/journal.pone.0251048
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75 Doher MP, Torres de Carvalho FR, Scherer PF, et al. Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil. Blood Purif;50(4-5):520-530. 2021 https://doi.org/10.1159/000513425 PMID: 33341806
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76 Kanbay, M., Medetalibeyoglu, A., Kanbay, A., Cevik, E., Tanriover, C., Baygul, A., Şenkal, N., Konyaoglu, H., Akpinar, T. S., Kose, M., Covic, A., & Tukek, T. (2021). Acute kidney injury in hospitalized COVID-19 patients. International urology and nephrology, 1-8. Advance online publication. https://doi.org/10.1007/s11255-021-02972-x PMID: 34410587
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77 Strohbehn, I. A., Zhao, S., Seethapathy, H., Lee, M., Rusibamayila, N., Allegretti, A. S., Parada, X. V., Sise, M. E. Acute kidney injury incidence, recovery, and long-term kidney outcomes among hospitalized patients with COVID-19 and influenza. Kidney International Reports, 6(10), 2565-2574. 2021. https://doi.org/10.1016/j.ekir.2021.07.008 PMID: 34307971
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78 Alfano, G., Ferrari, A., Fontana, F., Mori, G., Magistroni, R., Meschiari, M., Franceschini, E., Menozzi, M., Cuomo, G., Orlando, G., Santoro, A., Digaetano, M., Puzzolante, C., Carli, F., Bedini, A., Milic, J., Coloretti, I., Raggi, P., Mussini, C., Girardis, M., … Modena Covid-19 Working Group (MoCo19) (2021). Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19. Clinical and experimental nephrology, 25(11), 1203-1214. https://doi.org/10.1007/s10157-021-02092-x PMID: 34196877
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.

Também descobrimos que mais indivíduos com LRA necessitaram de ventilação mecânica (aproximadamente 7300 pacientes, 67,88%) do que aqueles sem LRA (3450 pacientes, 32,12%). Além disso, comparamos o número de óbitos entre pacientes com e sem LRA. Mais indivíduos com LRA foram a óbito (aproximadamente 39,2%) do que aqueles sem LRA.

A Tabela 3 apresenta a avaliação da TRS em pacientes com LRA. A TRS foi administrada a 2045 pacientes, dos quais 53,44% foram a óbito e 15,6% necessitaram de TRSC. Embora estas informações sejam relevantes para nosso estudo, a maioria dos artigos não apresentou dados relativos à TRS. Portanto, não foi possível estabelecer uma relação quanto à eficácia da TRS nestes pacientes.

Insuficiência cardíaca e doença renal crônica foram mais frequentes em pacientes com LRA do que naqueles sem LRA (Figura 2). Entretanto, a incidência de diabetes e hipertensão foi maior em pacientes sem LRA do que naqueles com LRA. Não obstante, essas comorbidades permanecem significativas em pacientes com LRA. Em relação aos pacientes transplantados e cirróticos, quase todos os artigos não apresentaram dados suficientes para desenvolver uma hipótese. O tabagismo contribuiu significativamente para o desenvolvimento de LRA, assim como a obesidade (Figura 2).

Poucos artigos relataram os medicamentos utilizados no tratamento da COVID-19 (Figura 3). Os medicamentos vasopressores foram mais comuns entre os pacientes com LRA (cerca de 5631 administrações). Os medicamentos mais comuns utilizados cronicamente antes da infecção por SARS-CoV-2 foram os bloqueadores da angiotensina II (1268 pacientes) e os inibidores da enzima conversora de angiotensina (1828 pacientes) (Figura 3). Outras drogas relacionadas à LRA em pacientes com COVID-19 foram a hidroxicloroquina (707 pacientes) e a azitromicina (546 pacientes).

Figura 3
Medicamentos utilizados em pacientes com COVID-191010 Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, et al. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med. 2020 Nov;20:290. DOI: https://doi.org/10.1186/s12890-020-01305-5
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35 Dai Y, Liu Z, Du X, et al. Acute Kidney Injury in Hospitalized Patients Infected with COVID-19 from Wuhan, China: A Retrospective Study. Biomed Res Int. 2021;2021:6655185. Published 2021 Jan 11. PMID: 33506027; https://doi.org/10.1155/2021/6655185
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36 Zheng X, Yang H, Li X, et al. Prevalence of Kidney Injury and Associations with Critical Illness and Death in Patients with COVID-19. Clin J Am Soc Nephrol. 2020;15(11):1549-1556. PMID: 32943396; https://doi.org/10.2215/CJN.04780420
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37 Trabulus S, Karaca C, Balkan II, et al. Kidney function on admission predicts in-hospital mortality in COVID-19. PLoS One. 2020;15(9):e0238680. Published 2020 Sep 3. PMID: 32881976; https://doi.org/10.1371/journal.pone.0238680
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43 Li Q, Zhang T, Li F, et al. Acute Kidney Injury Can Predict In-Hospital Mortality in Elderly Patients with COVID-19 in the ICU: A Single-Center Study. Clin Interv Aging. 2020;15:2095-2107. PMID: 33204075; https://doi.org/10.2147/cia.s273720
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44 Husain-Syed F, Wilhelm J, Kassoumeh S, et al. Acute kidney injury and urinary biomarkers in hospitalized patients with coronavirus disease-2019. Nephrol Dial Transplant. 2020;35(7):1271-1274. PMID: 32691068; https://doi.org/10.1093/ndt/gfaa162
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45 Chan L, Chaudhary K, Saha A, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151-160. PMID: 32883700; https://doi.org/10.1681/asn.2020050615
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46 Nalesso F, Garzotto F, Cattarin L, et al. A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19. J Clin Med. 2020;9(5):1529. PMID: 32438617; https://doi.org/10.3390/jcm9051529
https://doi.org/10.3390/jcm9051529...

47 Yildirim C, Ozger HS, Yasar E, et al. Early predictors of acute kidney injury in COVID-19 patients. Nephrology (Carlton). 2021;26(6):513-521. PMID: 33502771; https://doi.org/10.1111/nep.13856
https://doi.org/10.1111/nep.13856...
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https://doi.org/10.1053/j.ajkd.2020.09.0...
,5050 Zahid U, Ramachandran P, Spitalewitz S, et al. Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications. Am J Nephrol. 2020;51(10):786-796. PMID: 33011717; https://doi.org/10.1159/000511160
https://doi.org/10.1159/000511160...
,5151 Hamilton P, Hanumapura P, Castelino L, et al. Characteristics and outcomes of hospitalized patients with acute kidney injury and COVID-19. PLoS One. 2020;15(11):e0241544. PMID: 33141867; https://doi.org/10.1371/journal.pone.0241544
https://doi.org/10.1371/journal.pone.024...

52 Costa RLD, Sória TC, Salles EF, et al. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality [published online ahead of print, 2021 Feb 10]. J Bras Nefrol. 2021; S0101-28002021005014301. PMID: 33570081; https://doi.org/10.1590/2175-8239-jbn-2020-0144
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53 Gupta S, Coca SG, Chan L, et al. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):161-176. PMID: 33067383; https://doi.org/10.1681/asn.2020060897
https://doi.org/10.1681/asn.2020060897...

54 Xu J, Xie J, Du B, Tong Z, Qiu H, Bagshaw SM. Clinical Characteristics and Outcomes of Patients With Severe COVID-19 Induced Acute Kidney Injury. J Intensive Care Med. 2021;36(3):319-326. PMID: 33267722; https://doi.org/10.1177/0885066620970858
https://doi.org/10.1177/0885066620970858...

55 Khalili S, Sabaghian T, Sedaghat M, Soroureddin Z, Askari E, Khalili N. Prevalence, Risk Factors and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized for COVID-19: A Comparative Study between Diabetic and Nondiabetic Patients. J Diabetes Res. 2021; 2021:6666086. PMID: 33506050; https://doi.org/10.1155/2021/6666086
https://doi.org/10.1155/2021/6666086...

56 Charytan DM, Parnia S, Khatri M, et al. Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City. Kidney Int Rep. 2021;6(4):916-927. PMID: 33558853; https://doi.org/10.1016/j.ekir.2021.01.036
https://doi.org/10.1016/j.ekir.2021.01.0...

57 Lowe R, Ferrari M, Nasim-Mohi M, et al. Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single-center cohort study. BMC Nephrol. 2021;22(1):92. PMID: 33722189; https://doi.org/10.1186/s12882-021-02296-z
https://doi.org/10.1186/s12882-021-02296...

58 Piñeiro GJ, Molina-Andújar A, Hermida E, et al. Severe acute kidney injury in critically ill COVID-19 patients. J Nephrol. 2021;34(2):285-293. PMID: 33387345; https://doi.org/10.1007/s40620-020-00918-7
https://doi.org/10.1007/s40620-020-00918...

59 Murt A, Dincer MT, Karaca C, et al. Acute Kidney Injuries in different stages of COVID-19: An analysis on patients without prior kidney disease. Research Square; 2021. https://doi.org/10.21203/rs.3.rs-105205/v5
https://doi.org/10.21203/rs.3.rs-105205/...

60 Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19. Clin J Am Soc Nephrol. 2020;16(1):14-25. PMID: 33199414; https://doi.org/10.2215/cjn.09610620
https://doi.org/10.2215/cjn.09610620...

61 Hansrivijit P, Gadhiya KP, Gangireddy M, Goldman JD. Risk Factors, Clinical Characteristics, and Prognosis of Acute Kidney Injury in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Medicines (Basel). 2021;8(1):4. PMID: 33430296; https://doi.org/10.3390/medicines8010004
https://doi.org/10.3390/medicines8010004...

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.

Informações sobre a influência da LRA e o uso de ventilação mecânica em pacientes hospitalizados por COVID-19 apresentadas nos artigos foram extraídas e analisadas estatisticamente. Na maioria dos artigos, houve um maior número de óbitos em pacientes que apresentaram LRA durante a internação, em comparação àqueles sem LRA. Neste sentido, concluiu-se que a chance de pacientes com LRA virem a óbito é maior do que em indivíduos sem LRA [OR 6,03; IC95%: 5,73-6,74; p<0,01]. (Figura 4)

Figura 4
Forest plot da associação de lesão renal aguda e número de óbitos.

Com base nos dados, constatou-se também que a ventilação mecânica é um fator agravante para LRA, que pode estar relacionado ao agravamento das condições clínicas estudadas [OR 11,01; IC95%: 10,29-11,77; p<0,01] (Figura 5).

Figura 5
Forest plot da associação de ventilação mecânica e lesão renal aguda.

Os dados apresentados por estes artigos sobre os medicamentos utilizados durante a internação e a possível correlação com as comorbidades trouxeram cálculos inconclusivos e, portanto, não são mostrados no presente estudo.

Discussão

Quanto aos critérios de seleção da coorte, 39 artigos tiveram a pontuação mais alta, o que significa que incluíram uma coorte bastante abrangente e a população não exposta foi selecionada da mesma comunidade que a exposta, proporcionando resultados de pesquisa mais confiáveis. Além disso, todos os artigos foram baseados em registros médicos e demonstraram que o desfecho de interesse não estava presente no início da análise, garantindo confiabilidade aos resultados e segurança das fontes de dados. Alguns artigos restringiram a coorte a um grupo específico, enquanto outros não especificaram se o grupo não exposto foi retirado da mesma população que o grupo exposto, e apenas um não deixou claro se o desfecho de interesse estava presente nos pacientes previamente ao início do estudo. No entanto, esses fatores por si só não afetaram significativamente a qualidade desses estudos.

Quanto à comparabilidade dos dados, foram estabelecidos critérios fundamentais para avaliar os artigos, com dados especificados ao longo dos textos dos estudos selecionados. Estes dados incluíram: idade, sexo, estágio da LRA (uma estrela), ventilação mecânica, presença de comorbidades e a necessidade de TRS (uma estrela). A maioria dos artigos mostrou todos os dados que são extremamente úteis para uma análise holística do quadro clínico de pacientes internados por COVID-19 e também permitem maiores correlações entre os dados. Uma parte significativa dos artigos falhou com alguns dos itens do segundo grupo de dados, e a maioria deles não apresentou dados sobre a necessidade de TRS em indivíduos com LRA. Isto impossibilitou uma análise mais profunda do impacto clínico da COVID-19 na LRA, mas não comprometeu as demais correlações necessárias para a realização deste estudo.

Quanto ao último critério, que trata dos desfechos, a maioria dos artigos obteve uma pontuação máxima de 3 estrelas, uma vez que os resultados desses estudos foram comparados com base nos prontuários dos pacientes (uma estrela), o acompanhamento dos pacientes foi adequado (uma estrela), e todos ou quase todos os aspectos foram considerados no acompanhamento (uma estrela). Isto permitiu comparar os dados entre os artigos e, consequentemente, discutir as possíveis relações de causa e efeito encontradas nas condições clínicas e patológicas dos pacientes. Todos os artigos que não atingiram a pontuação total não apresentaram acompanhamento por tempo suficiente para observar os resultados após o tratamento das doenças, tornando impossível a análise de um espectro mais amplo dos efeitos da LRA nos pacientes com COVID-19. Entretanto, esses artigos foram mantidos devido à riqueza de dados e sua inclusão não comprometeu a análise dos demais artigos. Os dados dos pacientes foram compilados a partir dos artigos incluídos e, em seguida, foi avaliada a associação com possíveis repercussões clínicas decorrentes do desenvolvimento de LRA. Procuramos estabelecer critérios para analisar comorbidades, diagnósticos renais correlacionados com a COVID-19 e desfechos clínicos (tratamento contínuo com TRS ou óbito) dos pacientes. No entanto, a maioria dos artigos não forneceu dados essenciais relativos ao curso clínico de pacientes com bom prognóstico após tratamento com terapia renal substitutiva.

Todos os dados listados neste estudo reforçaram que a LRA é uma das complicações que mais frequentemente acometem os pacientes internados em UTI. Entre os pacientes internados por COVID-19, a LRA demonstrou uma importante prevalência, sendo um fator agravante para a condição clínica desses pacientes e aumentando consideravelmente a taxa de mortalidade.

A ventilação mecânica em pacientes com COVID-19 é um dos principais recursos terapêuticos utilizados8080 Cunha NVA, Santana BS, Duarte TTP, Lima WL, Nava LF, Magro MCS. Pressão positiva na ventilação mecânica invasiva e implicações renais em pacientes críticos. Revista de Enfermagem do Centro-Oeste Mineiro. 2019;9e3505. http://dx.doi.org/10.19175/recom.v9i0.3505
http://dx.doi.org/10.19175/recom.v9i0.35...
. Pode causar pressão intratorácica elevada com diminuição do débito cardíaco e diminuição da perfusão renal, com consequente lesão das células tubulares renais8181 Ahmed AR, Obilana A, Lappin D. Renal Replacement Therapy in the Critical Care Setting. Crit Care Res Pract. 2019;2019:6948710. PMID: 31396416; https://doi.org/10.1155/2019/6948710
https://doi.org/10.1155/2019/6948710...
. Neste contexto, portanto, a análise estatística permitiu estabelecer a relação entre ventilação mecânica e LRA relacionada à COVID-19. Na verdade, o presente estudo mostrou que a ventilação mecânica é um fator de risco para o desenvolvimento de LRA em pacientes infectados com SARS-CoV-2.

Em relação às comorbidades, o presente estudo mostrou uma relação entre a presença de doenças crônicas e o risco de LRA em pacientes com COVID-19. Um indivíduo com diabetes mellitus e hipertensão arterial por seis meses apresenta um risco maior de desenvolvimento de LRA. Os medicamentos utilizados também devem ser avaliados quanto à potencial nefrotoxicidade e, quando necessário, as doses devem ser ajustadas para evitar danos renais8282 Rigonatto MCL & Magro, M CDS. Risco para lesão renal aguda na atenção primária à saúde. Revista Brasileira de Enfermagem. 71(1): 20-25, 2018. PMID: 29324940; https://doi.org/10.1590/0034-7167-2016-0551
https://doi.org/10.1590/0034-7167-2016-0...
.

Além disso, o tabagismo e a obesidade estiveram entre os fatores predisponentes para um pior prognóstico nestes pacientes. Estudos demonstraram que a fumaça do tabaco contém mais de 4000 partículas e gases, alguns dos quais são nefrotóxicos8383 Elihimas Júnior UF, Elihimas HCDS, Lemos VM, Leão MDA, Sá MPBDO, França EET, Lemos A, Valente LM & Markman Filho B. Tabagismo como fator de risco para a doença renal crônica: revisão sistemática. Brazilian Journal of Nephrology. 36(4): 519-528, 2014. https://doi.org/10.5935/0101-2800.20140074
https://doi.org/10.5935/0101-2800.201400...
. A obesidade também exerce influência8484 Silva Junior GB, Bentes A CSN, Daher, EDF & Matos, SMA. Obesity and kidney disease. Brazilian Journal of Nephrology. 2017; 39(1): 65-69. PMID: 28355395; https://doi.org/10.5935/0101-2800.20170011
https://doi.org/10.5935/0101-2800.201700...
. Embora esta relação possa ser encontrada dentro dos estudos, a falta de dados na maioria dos artigos impossibilitou a realização de um cálculo estatístico preciso, o que demonstra a necessidade de uma coleta de dados mais eficaz e detalhada em estudos futuros.

Com relação à terapia medicamentosa utilizada em pacientes com COVID-19, o estudo mostrou associações entre os mecanismos de determinados medicamentos e a patogênese do vírus, no que diz respeito ao agravamento da condição clínica.

Estudos anteriores demonstraram que aproximadamente 70% dos pacientes que iniciaram o tratamento com drogas vasopressoras desenvolveram LRA durante a terapia8585 Ng JH, Hirsch JS, Hazzan A, et al. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis. 2021;77(2):204-215.e1. PMID: 32961245; https://dx.doi.org/10.1053%2Fj.ajkd.2020.09.002
https://dx.doi.org/10.1053%2Fj.ajkd.2020...
. Portanto, como o SARS-CoV-2 usa a ECA-2 para penetrar na célula, um estudo sugeriu que o tratamento com inibidores da ECA ou bloqueadores dos receptores da angiotensina 2 pode aumentar o risco de complicações graves associadas à COVID-198686 Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-574. PMID: 32007145; https://doi.org/10.1016/s0140-6736(20)30251-8
https://doi.org/10.1016/s0140-6736(20)30...
, mas isso não é corroborado por outros pesquisadores. No entanto, assim como a apresentação de comorbidades, a apresentação dos medicamentos utilizados durante a internação dos pacientes não foi eficaz, dificultando o cálculo estatístico e exigindo mais estudos sobre este tema.

Conclusão

Nosso estudo encontrou que a infecção por SARS-CoV-2 esteve relacionada ao desenvolvimento de LRA e que a LRA é uma complicação relevante nos casos de hospitalização por COVID-19. Entretanto, também cabe ressaltar que as comorbidades podem estar relacionadas a casos mais graves de LRA. Além disso, o número de óbitos foi consideravelmente maior entre os indivíduos com LRA do que entre os sem LRA. Também é importante mencionar que a ventilação mecânica pode ser um fator agravante e deve ser tratada com cautela.

Os artigos incluídos não forneceram dados suficientes para concluir sobre a eficácia da TRS e dos tratamentos medicamentosos. Além disso, a maioria dos artigos não forneceu dados essenciais sobre o curso clínico de pacientes com bom prognóstico após a TRS e quase todos os artigos não apresentaram dados suficientes para estabelecer uma hipótese sobre pacientes transplantados e cirróticos com comprometimento renal. Consequentemente, são necessários ensaios clínicos randomizados e controlados e estudos de prevalência e incidência para analisar todos os fatores de influência potenciais correlacionados com a progressão da LRA em pacientes infectados por SARS-CoV-2.

Material Suplementar

O seguinte material online está disponível para este artigo:

Apêndice 1 - Estratégia de pesquisa.

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Datas de Publicação

  • Publicação nesta coleção
    15 Jul 2022
  • Data do Fascículo
    Oct-Dec 2022

Histórico

  • Recebido
    21 Jan 2022
  • Aceito
    03 Maio 2022
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