Acute kidney injury in patients hospitalized with COVID-19 from the ISARIC WHO CCP-UK Study: a prospective, multicentre cohort study
Authors: Sullivan Michael K , Lees Jennifer S , Drake Thomas M , Docherty Annemarie B , Oates Georgia , Hardwick Hayley E , Russell Clark D , Merson Laura , Dunning Jake , Nguyen-Van-Tam Jonathan S , Openshaw Peter , Harrison Ewen M , Baillie J Kenneth ,   ISARIC4C Investigators, Baillie J Kenneth , Semple Malcolm G , Openshaw Peter J M , Carson Gail , Alex Beatrice , Bach Benjamin , Barclay Wendy S , Bogaert Debby , Chand Meera , Cooke Graham S , Docherty Annemarie B , Dunning Jake , da Silva Filipe Ana , Fletcher Tom , Green Christoper A , Harrison Ewen M , Hiscox Julian A , Ho Antonia Ying Wai , Horby Peter W , Ijaz Samreen , Khoo Saye , Klenerman Paul , Law Andrew , Lim Wei Shen , Mentzer Alexander J , Merson Laura , Meynert Alison M , Noursadeghi Mahdad , Moore Shona C , Palmarini Massimo , Paxton William A , Pollakis Georgios , Price Nicholas , Rambaut Andrew , Robertson David L , Russell Clark D , Sancho-Shimizu Vanessa , Scott Janet T , de Silva Thushan , Sigfrid Louise , Solomon Tom , Sriskandan Shiranee , Stuart David , Summers Charlotte , Tedder Richard S , Thomson Emma C , Thompson A A Roger , Thwaites Ryan S , Turtle Lance C W , Zambon Maria , Hardwick Hayley , Donohue Chloe , Lyons Ruth , Griffiths Fiona , Oosthuyzen Wilna , Norman Lisa , Pius Riinu , Drake Thomas M , Fairfield Cameron J , Knight Stephen R , Mclean Kenneth A , Murphy Derek , Shaw Catherine A , Dalton Jo , Girvan Michelle , Saviciute Egle , Roberts Stephanie , Harrison Janet , Marsh Laura , Connor Marie , Halpin Sophie , Jackson Clare , Gamble Carrol , Leeming Gary , Law Andrew , Wham Murray , Clohisey Sara , Hendry Ross , Scott-Brown James , Greenhalf William , Shaw Victoria , McDonald Sara , Keating Seán , Ahmed Katie A , Armstrong Jane A , Ashworth Milton , Asiimwe Innocent G , Bakshi Siddharth , Barlow Samantha L , Booth Laura , Brennan Benjamin , Bullock Katie , Catterall Benjamin W A , Clark Jordan J , Clarke Emily A , Cole Sarah , Cooper Louise , Cox Helen , Davis Christopher , Dincarslan Oslem , Dunn Chris , Dyer Philip , Elliott Angela , Evans Anthony , Finch Lorna , Fisher Lewis W S , Foster Terry , Garcia-Dorival Isabel , Greenhalf William , Gunning Philip , Hartley Catherine , Jensen Rebecca L , Jones Christopher B , Jones Trevor R , Khandaker Shadia , King Katharine , Kiy Robyn T , Koukorava Chrysa , Lake Annette , Lant Suzannah , Latawiec Diane , Lavelle-Langham Lara , Lefteri Daniella , Lett Lauren , Livoti Lucia A , Mancini Maria , McDonald Sarah , McEvoy Laurence , McLauchlan John , Metelmann Soeren , Miah Nahida S , Middleton Joanna , Mitchell Joyce , Moore Shona C , Murphy Ellen G , Penrice-Randal Rebekah , Pilgrim Jack , Prince Tessa , Reynolds Will , Ridley P Matthew , Sales Debby , Shaw Victoria E , Shears Rebecca K , Small Benjamin , Subramaniam Krishanthi S , Szemiel Agnieska , Taggart Aislynn , Tanianis-Hughes Jolanta , Thomas Jordan , Trochu Erwan , van Tonder Libby , Wilcock Eve , Zhang J Eunice , Flaherty Lisa , Maziere Nicole , Cass Emily , Carracedo Alejandra Doce , Carlucci Nicola , Holmes Anthony , Massey Hannah , Murphy Lee , Wrobel Nicola , McCafferty Sarah , Morrice Kirstie , MacLean Alan , Adeniji Kayode , Agranoff Daniel , Agwuh Ken , Ail Dhiraj , Aldera Erin L , Alegria Ana , Angus Brian , Ashish Abdul , Atkinson Dougal , Bari Shahedal , Barlow Gavin , Barnass Stella , Barrett Nicholas , Bassford Christopher , Basude Sneha , Baxter David , Beadsworth Michael , Bernatoniene Jolanta , Berridge John , Best Nicola , Bothma Pieter , Chadwick David , Brittain-Long Robin , Bulteel Naomi , Burden Tom , Burtenshaw Andrew , Caruth Vikki , Chadwick David , Chambler Duncan , Chee Nigel , Child Jenny , Chukkambotla Srikanth , Clark Tom , Collini Paul , Cosgrove Catherine , Cupitt Jason , Cutino-Moguel Maria-Teresa , Dark Paul , Dawson Chris , Dervisevic Samir , Donnison Phil , Douthwaite Sam , DuRand Ingrid , Dushianthan Ahilanadan , Dyer Tristan , Evans Cariad , Eziefula Chi , Fegan Chrisopher , Finn Adam , Fullerton Duncan , Garg Sanjeev , Garg Sanjeev , Garg Atul , Gkrania-Klotsas Effrossyni , Godden Jo , Goldsmith Arthur , Graham Clive , Hardy Elaine , Hartshorn Stuart , Harvey Daniel , Havalda Peter , Hawcutt Daniel B , Hobrok Maria , Hodgson Luke , Hormis Anil , Jacobs Michael , Jain Susan , Jennings Paul , Kaliappan Agilan , Kasipandian Vidya , Kegg Stephen , Kelsey Michael , Kendall Jason , Kerrison Caroline , Kerslake Ian , Koch Oliver , Koduri Gouri , Koshy George , Laha Shondipon , Laird Steven , Larkin Susan , Leiner Tamas , Lillie Patrick , Limb James , Linnett Vanessa , Little Jeff , Lyttle Mark , MacMahon Michael , MacNaughton Emily , Mankregod Ravish , Masson Huw , Matovu Elijah , McCullough Katherine , McEwen Ruth , Meda Manjula , Mills Gary , Minton Jane , Mirfenderesky Mariyam , Mohandas Kavya , Mok Quen , Moon James , Moore Elinoor , Morgan Patrick , Morris Craig , Mortimore Katherine , Moses Samuel , Mpenge Mbiye , Mulla Rohinton , Murphy Michael , Nagel Megan , Nagarajan Thapas , Nelson Mark , O'Shea Matthew K , Otahal Igor , Ostermann Marlies , Pais Mark , Panchatsharam Selva , Papakonstantinou Danai , Paraiso Hassan , Patel Brij , Pattison Natalie , Pepperell Justin , Peters Mark , Phull Mandeep , Pintus Stefania , Pooni Jagtur Singh , Post Frank , Price David , Prout Rachel , Rae Nikolas , Reschreiter Henrik , Reynolds Tim , Richardson Neil , Roberts Mark , Roberts Devender , Rose Alistair , Rousseau Guy , Ryan Brendan , Saluja Taranprit , Shah Aarti , Shanmuga Prad , Sharma Anil , Shawcross Anna , Sizer Jeremy , Shankar-Hari Manu , Smith Richard , Snelson Catherine , Spittle Nick , Staines Nikki , Stambach Tom , Stewart Richard , Subudhi Pradeep , Szakmany Tamas , Tatham Kate , Thomas Jo , Thompson Chris , Thompson Robert , Tridente Ascanio , Tupper-Carey Darell , Twagira Mary , Ustianowski Andrew , Vallotton Nick , Vincent-Smith Lisa , Visuvanathan Shico , Vuylsteke Alan , Waddy Sam , Wake Rachel , Walden Andrew , Welters Ingeborg , Whitehouse Tony , Whittaker Paul , Whittington Ashley , Papineni Padmasayee , Wijesinghe Meme , Williams Martin , Wilson Lawrence , Cole Sarah , Winchester Stephen , Wiselka Martin , Wolverson Adam , Wooton Daniel G , Workman Andrew , Yates Bryan , Young Peter , Semple Malcolm G , Ho Antonia , Mark Patrick B 
Published: October 2021

ABSTRACT

Background
Acute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19). This study investigated adults hospitalized with COVID-19 and hypothesized that risk factors for AKI would include comorbidities and non-White race.

Methods
A prospective multicentre cohort study was performed using patients admitted to 254 UK hospitals with COVID-19 between 17 January 2020 and 5 December 2020.

Results
Of 85 687 patients, 2198 (2.6%) received acute kidney replacement therapy (KRT). Of 41 294 patients with biochemistry data, 13 000 (31.5%) had biochemical AKI: 8562 stage 1 (65.9%), 2609 stage 2 (20.1%) and 1829 stage 3 (14.1%). The main risk factors for KRT were chronic kidney disease (CKD) [adjusted odds ratio (aOR) 3.41: 95% confidence interval 3.06–3.81], male sex (aOR 2.43: 2.18–2.71) and Black race (aOR 2.17: 1.79–2.63). The main risk factors for biochemical AKI were admission respiratory rate &gt;30 breaths per minute (aOR 1.68: 1.56–1.81), CKD (aOR 1.66: 1.57–1.76) and Black race (aOR 1.44: 1.28–1.61). There was a gradated rise in the risk of 28-day mortality by increasing severity of AKI: stage 1 aOR 1.58 (1.49–1.67), stage 2 aOR 2.41 (2.20–2.64), stage 3 aOR 3.50 (3.14–3.91) and KRT aOR 3.06 (2.75–3.39). AKI rates peaked in April 2020 and the subsequent fall in rates could not be explained by the use of dexamethasone or remdesivir.

Conclusions
AKI is common in adults hospitalized with COVID-19 and it is associated with a heightened risk of mortality. Although the rates of AKI have fallen from the early months of the pandemic, high-risk patients should have their kidney function and fluid status monitored closely.