Background: While acute kidney injury (AKI) is a common complication in COVID-19, data on post-AKI kidney function recovery and the clinical factors associated with poor kidney function recovery is lacking. Methods: A retrospective multi-centre observational cohort study comprising 12,891 hospitalized patients aged 18 years or older with a diagnosis of SARS-CoV-2 infection confirmed by polymerase chain reaction from 1 January 2020 to 10 September 2020, and with at least one serum creatinine value 1–365 days prior to admission. Mortality and serum creatinine values were obtained up to 10 September 2021. Findings: Advanced age (HR 2.77, 95%CI 2.53–3.04, p < 0.0001), severe COVID-19 (HR 2.91, 95%CI 2.03–4.17, p < 0.0001), severe AKI (KDIGO stage 3: HR 4.22, 95%CI 3.55–5.00, p < 0.0001), and ischemic heart disease (HR 1.26, 95%CI 1.14–1.39, p < 0.0001) were associated with worse mortality outcomes. AKI severity (KDIGO stage 3: HR 0.41, 95%CI 0.37–0.46, p < 0.0001) was associated with worse kidney function recovery, whereas remdesivir use (HR 1.34, 95%CI 1.17–1.54, p < 0.0001) was associated with better kidney function recovery. In a subset of patients without chronic kidney disease, advanced age (HR 1.38, 95%CI 1.20–1.58, p < 0.0001), male sex (HR 1.67, 95%CI 1.45–1.93, p < 0.0001), severe AKI (KDIGO stage 3: HR 11.68, 95%CI 9.80–13.91, p < 0.0001), and hypertension (HR 1.22, 95%CI 1.10–1.36, p = 0.0002) were associated with post-AKI kidney function impairment. Furthermore, patients with COVID-19-associated AKI had significant and persistent elevations of baseline serum creatinine 125% or more at 180 days (RR 1.49, 95%CI 1.32–1.67) and 365 days (RR 1.54, 95%CI 1.21–1.96) compared to COVID-19 patients with no AKI. Interpretation: COVID-19-associated AKI was associated with higher mortality, and severe COVID-19-associated AKI was associated with worse long-term post-AKI kidney function recovery. Funding: Authors are supported by various funders, with full details stated in the acknowledgement section.
Bibliographical noteFunding Information:
BWQT is supported by the National Medical Research Council Research Training Fellowship (MOH-000195-00). WY is supported by the National Institutes of Health (NIH) (T32HD040128). MH is supported by the NIH National Library of Medicine (NLM) (5T32LM012203-05). NGB is supported by Carlos III Health Institute (PI18/00981). NA is supported by the NIH National Center for Advancing Translational Science (NCATS) (CTSA Award #UL1TR002366). LPP is supported by the NIH NCATS (CTSA Award #UL1TR002366). AMS is supported by the NIH National Heart Lung and Blood Institute (NHLBI) (K23HL148394, L40HL148910) and NCATS (UL1TR001420). SV is supported by the NIH NLM (R01LM012095) and NCATS (UL1TR001857). DAH is supported by NIH NCATS (UL1TR002240). ML is supported by the NIH NCATS (CTSA Award #UL1TR002366) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (R01DK116986). DLM is supported by the NIH NCATS CSTA award (UL1-TR001878). YL is supported by NIH NLM (1R01LM013337). RB is supported by European Union Periscope Project (101016233). ZX is supported by the NIH National Institute of Neurological Disorders and Stroke (NINDS) (R01NS098023). GMW is supported by NIH NCATS (UL1TR002541 and UL1TR000005), NIH NLM (R01LM013345) and NIH NHGRI (3U01HG008685-05S2). GSO is supported by the NIH (P30ES017885, U24CA210967). JHH is supported by NIH/NCATS Institutional Clinical and Translational Science Award (UL1-TR001878).
- Acute kidney injury
- Chronic kidney disease
- Electronic health records
ASJC Scopus subject areas
- Medicine (all)