Kidney involvement in leptospirosis: a systematic review and meta-analysis

Introduction: From a public health perspective, it is essential to understand the burden of kidney involvement in leptospirosis. We aimed to assess the frequency of acute kidney injury (AKI) and chronic kidney disease (CKD) in patients with leptospirosis. Methodology: This systematic review and meta-analysis included all articles up to 14.08.2024 from three databases (PubMed, Scopus, Web of Science) using search terms related to leptospirosis and kidney involvement. After de-duplication, two independent reviewers independently checked the articles in two phases (title-abstract and full-text), and a third reviewer adjudicated any conflicts. Patient demographics, diagnostic procedures, and details of kidney involvement were extracted from the included studies. Risk of bias analysis was done using the Joanna Briggs Institute critical appraisal tool. A random effects model estimated the pooled rates for AKI, oliguria, and the need for dialysis. Results: Of the 5913 retrieved articles, 48 met the eligibility criteria. The pooled incidence of AKI, reduced urine output, and dialysis requirement was 49.2% (95%CI: 38.2-60.2%, I² of 99.4%), 31.5% (95%CI: 24.2-38.7%, I²-96.1%) and 14.4% (95%CI: 10.3-18.4%, I²-97%) respectively. The pooled mean serum creatinine and urea levels at admission were 3.6 mg/dl (95% CI: 2.9–4.2, I²-99.1%) and 131.8 mg/dl (95% CI: 98.7-164.9, I²-98.6%), respectively. In four studies, the incidence of new-onset CKD after leptospirosis infection varied from 13 to 62%. Conclusion: AKI reduced urine output and the requirement for dialysis are frequent complications in patients with leptospirosis. Increased resources for their management in endemic areas are essential to mitigate the burden.