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

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; Investigators, ISARIC4C; Semple, Malcolm G; Ho, Antonia; Mark, Patrick B

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


Authors

Michael K Sullivan

Jennifer S Lees

Thomas M Drake

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



Contributors

J Kenneth Baillie
Project Leader

Peter JM Openshaw
Project Leader

Malcolm G Semple
Project Leader

Beatrice Alex
Researcher

Petros Andrikopoulos
Researcher

Benjamin Bach
Researcher

Wendy S Barclay
Researcher

Debby Bogaert
Researcher

Meera Chand
Researcher

Kanta Chechi
Researcher

Graham S Cooke
Researcher

Ana da Silva Filipe
Researcher

Thushan de Silva
Researcher

Annemarie B Docherty
Researcher

Gonçalo dos Santos Correia
Researcher

Marc-Emmanuel Dumas
Researcher

Jake Dunning
Researcher

Tom Fletcher
Researcher

Christoper A Green
Researcher

William Greenhalf
Researcher

Julian L Griffin
Researcher

Rishi K Gupta
Researcher

Ewen M Harrison
Researcher

Antonia Ying Wai Ho
Researcher

Karl Holden
Researcher

Peter W Horby
Researcher

Samreen Ijaz
Researcher

Saye Khoo
Researcher

Paul Klenerman
Researcher

Andrew Law
Researcher

Matthew R Lewis
Researcher

Sonia Liggi
Researcher

Wei Shen Lim
Researcher

Lynn Maslen
Researcher

Alexander J Mentzer
Researcher

Laura Merson
Researcher

Alison M Meynert
Researcher

Shona C Moore
Researcher

Mahdad Noursadeghi
Researcher

Michael Olanipekun
Researcher

Anthonia Osagie
Researcher

Massimo Palmarini
Researcher

Carlo Palmieri
Researcher

William A Paxton
Researcher

Georgios Pollakis
Researcher

Nicholas Price
Researcher

Andrew Rambaut
Researcher

David L Robertson
Researcher

Clark D Russell
Researcher

Vanessa Sancho-Shimizu
Researcher

Caroline J Sands
Researcher

Janet T Scott
Researcher

Louise Sigfrid
Researcher

Tom Solomon
Researcher

Shiranee Sriskandan
Researcher

David Stuart
Researcher

Charlotte Summers
Researcher

Olivia V Swann
Researcher

Zoltan Takats
Researcher

Panteleimon Takis
Researcher

Richard S Tedder
Researcher

AA Roger Thompson
Researcher

Emma C Thomson
Researcher

Ryan S Thwaites
Researcher

Lance CW Turtle
Researcher

Maria Zambon
Researcher

Thomas M Drake
Data Curator

Cameron J Fairfield
Data Curator

Stephen R Knight
Data Curator

Kenneth A Mclean
Data Curator

Derek Murphy
Data Curator

Lisa Norman
Data Curator

Riinu Pius
Data Curator

Catherine A Shaw
Data Curator

Marie Connor
Data Manager

Jo Dalton
Data Manager

Carrol Gamble
Data Manager

Michelle Girvan
Data Manager

Sophie Halpin
Data Manager

Janet Harrison
Data Manager

Clare Jackson
Data Manager

James Lee
Data Manager

Laura Marsh
Data Manager

Daniel Plotkin
Data Manager

Stephanie Roberts
Data Manager

Egle Saviciute
Data Manager

Sara Clohisey
Data Curator

Ross Hendry
Data Curator

Susan Knight
Data Curator

Eva Lahnsteiner
Data Curator

Andrew Law
Data Curator

Gary Leeming
Data Curator

Lucy Norris
Data Curator

James Scott-Brown
Data Curator

Sarah Tait
Data Curator

Murray Wham
Data Curator

Gail Carson
Project Member

Richard Clark
Research Group

Audrey Coutts
Research Group

Lorna Donnelly
Research Group

Angie Fawkes
Research Group

Tammy Gilchrist
Research Group

Katarzyna Hafezi
Research Group

Louise MacGillivray
Research Group

Alan Maclean
Research Group

Sarah McCafferty
Research Group

Kirstie Morrice
Research Group

Lee Murphy
Research Group

Nicola Wrobel
Research Group

Kayode Adeniji
Researcher

Daniel Agranoff
Researcher

Ken Agwuh
Researcher

Dhiraj Ail
Researcher

Erin L. Aldera
Researcher

Ana Alegria
Researcher

Sam Allen
Researcher

Brian Angus
Researcher

Abdul Ashish
Researcher

Dougal Atkinson
Researcher

Shahedal Bari
Researcher

Gavin Barlow
Researcher

Stella Barnass
Researcher

Nicholas Barrett
Researcher

Christopher Bassford
Researcher

Sneha Basude
Researcher

David Baxter
Researcher

Michael Beadsworth
Researcher

Jolanta Bernatoniene
Researcher

John Berridge
Researcher

Colin Berry
Researcher

Nicola Best
Researcher

Pieter Bothma
Researcher

Robin Brittain-Long
Researcher

Naomi Bulteel
Researcher

Tom Burden
Researcher

Andrew Burtenshaw
Researcher

Vikki Caruth
Researcher

David Chadwick
Researcher

David Chadwick
Researcher

Duncan Chambler
Researcher

Nigel Chee
Researcher

Jenny Child
Researcher

Srikanth Chukkambotla
Researcher

Tom Clark
Researcher

Paul Collini
Researcher

Catherine Cosgrove
Researcher

Jason Cupitt
Researcher

Maria-Teresa Cutino-Moguel
Researcher

Paul Dark
Researcher

Chris Dawson
Researcher

Samir Dervisevic
Researcher

Phil Donnison
Researcher

Sam Douthwaite
Researcher

Andrew Drummond
Researcher

Ingrid DuRand
Researcher

Ahilanadan Dushianthan
Researcher

Tristan Dyer
Researcher

Cariad Evans
Researcher

Chi Eziefula
Researcher

Chrisopher Fegan
Researcher

Adam Finn
Researcher

Duncan Fullerton
Researcher

Sanjeev Garg
Researcher

Atul Garg
Researcher

Effrossyni Gkrania-Klotsas
Researcher

Jo Godden
Researcher

Arthur Goldsmith
Researcher

Clive Graham
Researcher

Tassos Grammatikopoulos
Researcher

Elaine Hardy
Researcher

Stuart Hartshorn
Researcher

Daniel Harvey
Researcher

Peter Havalda
Researcher

Daniel B Hawcutt
Researcher

Maria Hobrok
Researcher

Luke Hodgson
Researcher

Anil Hormis
Researcher

Joanne Howard
Researcher

Michael Jacobs
Researcher

Susan Jain
Researcher

Paul Jennings
Researcher

Agilan Kaliappan
Researcher

Vidya Kasipandian
Researcher

Stephen Kegg
Researcher

Michael Kelsey
Researcher

Jason Kendall
Researcher

Caroline Kerrison
Researcher

Ian Kerslake
Researcher

Oliver Koch
Researcher

Gouri Koduri
Researcher

George Koshy
Researcher

Shondipon Laha
Researcher

Steven Laird
Researcher

Susan Larkin
Researcher

Tamas Leiner
Researcher

Patrick Lillie
Researcher

James Limb
Researcher

Vanessa Linnett
Researcher

Jeff Little
Researcher

Mark Lyttle
Researcher

Michael MacMahon
Researcher

Emily MacNaughton
Researcher

Ravish Mankregod
Researcher

Huw Masson
Researcher

Elijah Matovu
Researcher

Katherine McCullough
Researcher

Ruth McEwen
Researcher

Manjula Meda
Researcher

Gary Mills
Researcher

Jane Minton
Researcher

Kavya Mohandas
Researcher

Quen Mok
Researcher

James Moon
Researcher

Elinoor Moore
Researcher

Patrick Morgan
Researcher

Craig Morris
Researcher

Katherine Mortimore
Researcher

Samuel Moses
Researcher

Mbiye Mpenge
Researcher

Rohinton Mulla
Researcher

Michael Murphy
Researcher

Thapas Nagarajan
Researcher

Megan Nagel
Researcher

Mark Nelson
Researcher

Lillian Norris
Researcher

Matthew K. O’Shea
Researcher

Marlies Ostermann
Researcher

Igor Otahal
Researcher

Mark Pais
Researcher

Carlo Palmieri
Researcher

Selva Panchatsharam
Researcher

Padmasayee Papineni
Researcher

Hassan Paraiso
Researcher

Brij Patel
Researcher

Natalie Pattison
Researcher

Justin Pepperell
Researcher

Mark Peters
Researcher

Mandeep Phull
Researcher

Stefania Pintus
Researcher

Tim Planche
Researcher

Frank Post
Researcher

David Price
Researcher

Rachel Prout
Researcher

Nikolas Rae
Researcher

Henrik Reschreiter
Researcher

Tim Reynolds
Researcher

Neil Richardson
Researcher

Mark Roberts
Researcher

Devender Roberts
Researcher

Alistair Rose
Researcher

Guy Rousseau
Researcher

Bobby Ruge
Researcher

Brendan Ryan
Researcher

Taranprit Saluja
Researcher

Sarah Cole
Researcher

Matthias L Schmid
Researcher

Aarti Shah
Researcher

Manu Shankar-Hari
Researcher

Prad Shanmuga
Researcher

Anil Sharma
Researcher

Anna Shawcross
Researcher

Jagtur Singh Pooni
Researcher

Jeremy Sizer
Researcher

Richard Smith
Researcher

Catherine Snelson
Researcher

Nick Spittle
Researcher

Nikki Staines
Researcher

Tom Stambach
Researcher

Richard Stewart
Researcher

Pradeep Subudhi
Researcher

Tamas Szakmany
Researcher

Kate Tatham
Researcher

Jo Thomas
Researcher

Chris Thompson
Researcher

Robert Thompson
Researcher

Ascanio Tridente
Researcher

Darell Tupper-Carey
Researcher

Mary Twagira
Researcher

Nick Vallotton
Researcher

Rama Vancheeswaran
Researcher

Rachel Vincent
Researcher

Lisa Vincent-Smith
Researcher

Shico Visuvanathan
Researcher

Alan Vuylsteke
Researcher

Sam Waddy
Researcher

Rachel Wake
Researcher

Andrew Walden
Researcher

Ingeborg Welters
Researcher

Tony Whitehouse
Researcher

Paul Whittaker
Researcher

Ashley Whittington
Researcher

Meme Wijesinghe
Researcher

Martin Williams
Researcher

Lawrence Wilson
Researcher

Stephen Winchester
Researcher

Martin Wiselka
Researcher

Adam Wolverson
Researcher

Daniel G Wootton
Researcher

Andrew Workman
Researcher

Bryan Yates
Researcher

Peter Young
Researcher

Sarah E McDonald
Data Collector

Victoria Shaw
Data Collector

Katie A. Ahmed
Research Group

Jane A Armstrong
Research Group

Milton Ashworth
Research Group

Innocent G Asiimwe
Research Group

Siddharth Bakshi
Research Group

Samantha L Barlow
Research Group

Laura Booth
Research Group

Benjamin Brennan
Research Group

Katie Bullock
Research Group

Nicola Carlucci
Research Group

Emily Cass
Research Group

Benjamin WA Catterall
Research Group

Jordan J Clark
Research Group

Emily A Clarke
Research Group

Sarah Cole
Research Group

Louise Cooper
Research Group

Helen Cox
Research Group

Christopher Davis
Research Group

Oslem Dincarslan
Research Group

Alejandra Doce Carracedo
Research Group

Chris Dunn
Research Group

Philip Dyer
Research Group

Angela Elliott
Research Group

Anthony Evans
Research Group

Lorna Finch
Research Group

Lewis WS Fisher
Research Group

Lisa Flaherty
Research Group

Terry Foster
Research Group

Isabel Garcia-Dorival
Research Group

Philip Gunning
Research Group

Catherine Hartley
Research Group

Anthony Holmes
Research Group

Rebecca L Jensen
Research Group

Christopher B Jones
Research Group

Trevor R Jones
Research Group

Shadia Khandaker
Research Group

Katharine King
Research Group

Robyn T. Kiy
Research Group

Chrysa Koukorava
Research Group

Annette Lake
Research Group

Suzannah Lant
Research Group

Diane Latawiec
Research Group

Lara Lavelle-Langham
Research Group

Daniella Lefteri
Research Group

Lauren Lett
Research Group

Lucia A Livoti
Research Group

Maria Mancini
Research Group

Hannah Massey
Research Group

Nicole Maziere
Research Group

Sarah McDonald
Research Group

Laurence McEvoy
Research Group

John McLauchlan
Research Group

Soeren Metelmann
Research Group

Nahida S Miah
Research Group

Joanna Middleton
Research Group

Joyce Mitchell
Research Group

Shona C Moore
Research Group

Ellen G Murphy
Research Group

Rebekah Penrice-Randal
Research Group

Jack Pilgrim
Research Group

Tessa Prince
Research Group

Will Reynolds
Research Group

P. Matthew Ridley
Research Group

Debby Sales
Research Group

Victoria E Shaw
Research Group

Rebecca K Shears
Research Group

Benjamin Small
Research Group

Krishanthi S Subramaniam
Research Group

Agnieska Szemiel
Research Group

Aislynn Taggart
Research Group

Jolanta Tanianis-Hughes
Research Group

Jordan Thomas
Research Group

Erwan Trochu
Research Group

Libby van Tonder
Research Group

Eve Wilcock
Research Group

J. Eunice Zhang
Research Group

Seán Keating
Project Member

Cara Donegan
Project Member

Rebecca G. Spencer
Project Member

Chloe Donohue
Project Manager

Fiona Griffiths
Project Manager

Hayley Hardwick
Project Manager

Wilna Oosthuyzen
Project Manager

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 >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.

Citation

Sullivan, M. K., Lees, J. S., Drake, T. M., Docherty, A. B., Oates, G., Hardwick, H. E., …Mark, P. B. (2022). Acute kidney injury in patients hospitalized with COVID-19 from the ISARIC WHO CCP-UK Study: a prospective, multicentre cohort study. Nephrology Dialysis Transplantation, 37(2), 271 - 284. https://doi.org/10.1093/ndt/gfab303

Journal Article Type Article
Acceptance Date Oct 18, 2021
Online Publication Date Jan 25, 2022
Publication Date 2022-02
Journal Nephrology Dialysis Transplantation
Print ISSN 0931-0509
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 37
Issue 2
Pages 271 - 284
DOI https://doi.org/10.1093/ndt/gfab303
Publisher URL https://academic.oup.com/ndt/article/37/2/271/6400122