Acute kidney injury in patients hospitalised with COVID-19 from the ISARIC WHO CCP-UK Study: a prospective, multicentre cohort study

Michael K. Sullivan, Jennifer S. Lees, Annemarie B Docherty, Georgia Oates, Hayley E. Hardwick, Clark D. Russell, Laura Merson, Jake Dunning, Jonathan S. Nguyen-Van-Tam, Peter Openshaw, Ewen M Harrison, J Kenneth Baillie, ISARIC4C Investigators, Malcolm G Semple, Antonia Ho, Patrick B. Mark

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Acute kidney injury (AKI) is common in COVID-19. This study investigated adults hospitalised with COVID-19 and hypothesised that risk factors for AKI would include co-morbidities and non-white race.
Methods: A prospective multicentre cohort study was performed using patients admitted to 254 UK hospitals with COVID-19 between January 17th 2020 and December 5th 2020.
Results: Of 85,687 patients, 2,198 (2.6%) received acute kidney replacement therapy (KRT). Of 41,294 patients with biochemistry data, 13,000 (31.5%) had biochemical AKI: 8,562 stage 1 (65.9%), 2,609 stage 2 (20.1%) and 1,829 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 >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); 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 hospitalised 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.

Study registration ISRCTN66726260. The ISARIC WHO CCP-UK study was registered at and designated an Urgent Public Health Research Study by NIHR.
Original languageEnglish
JournalPLoS Medicine
Early online date18 Oct 2021
Publication statusE-pub ahead of print - 18 Oct 2021


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