Mahalingasivam Viyaasan, Zheng Bang, Wing Kevin, Parker Edward P K, Bhaskaran Krishnan, Carrero Juan Jesús, Jayacodi Sandra, Jumbo Edith, Miah Tamanna, Gracey Brian, Tazare John, Santhakumaran Shalini, Mathur Rohini, Costello Ruth E, Herrett Emily, Wen Qing, Hartney Thomas, Douglas Ian J, Green Amelia, Fisher Louis, Curtis Helen J, Walker Alex J, MacKenna Brian, Hulme William J, Mehrkar Amir, Bacon Sebastian, Goldacre Ben, Williamson Elizabeth, Nitsch Dorothea, Mansfield Kathryn E, Tomlinson Laurie
Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Department of Nephrology & Transplantation, Barts Health NHS Trust, London, UK.
Lancet Reg Health Eur. 2025 Jun 18;55:101338. doi: 10.1016/j.lanepe.2025.101338. eCollection 2025 Aug.
COVID-19 severe enough to require hospitalisation is commonly associated with acute kidney injury. However, it remains unclear whether COVID-19 leads to long-term kidney outcomes in the broader population.
We undertook a population-based, matched cohort study. With the approval of NHS England, we used primary and secondary care electronic health records from England using the OpenSAFELY-TPP platform. We compared people with and without COVID-19 using fully-adjusted, stratified, cause-specific Cox models for kidney failure, 50% reduction in kidney function, and death.
Overall, all outcomes were increased after COVID-19 over the course of follow-up (HR for kidney failure 1.93 [95% CI 1.84-2.03]). Hazards of kidney failure were greatest after hospitalisation (HR 7.74 [95% CI 7.00-8.56]) and remained increased beyond 180 days of follow-up. There was no evidence of increased risk in those not hospitalised (HR 0.85 [95% CI 0.79-0.90]). Increased kidney failure was more pronounced in black ethnicity (HR 4.50 [95% CI 2.92-6.92]) compared to white ethnicity (HR 1.82 [95% CI 1.71-1.94]). Amongst those hospitalised with COVID-19, there was no attenuation of kidney failure between the first wave (HR 8.74 [95% CI 6.88-11.08]) and the Omicron wave (HR 8.36 [95% CI 6.81-10.27]).
We observed increased long-term kidney outcomes in people hospitalised with COVID-19, as well as notable ethnic differences. Our results suggest strategies to minimise severe COVID-19 should continue to be optimised among vulnerable groups, and that kidney function should be proactively monitored after hospital discharge.
National Institute for Health and Care Research.
严重到需要住院治疗的新型冠状病毒肺炎（COVID-19）通常与急性肾损伤相关。然而，COVID-19是否会导致更广泛人群出现长期肾脏问题仍不清楚。
我们进行了一项基于人群的匹配队列研究。在英国国民健康服务体系（NHS）英格兰地区的批准下，我们使用OpenSAFELY-TPP平台从英格兰的初级和二级医疗电子健康记录中获取数据。我们使用完全调整的、分层的、特定病因的Cox模型，对肾衰竭、肾功能降低50%和死亡情况，比较了感染COVID-19和未感染COVID-19的人群。
总体而言，在随访期间，COVID-19感染后的所有结局均有所增加（肾衰竭的风险比[HR]为1.93[95%置信区间（CI）为1.84 - 2.03]）。住院后肾衰竭的风险最高（HR为7.74[95%CI为7.00 - 8.56]），并且在随访180天后仍保持升高。没有证据表明未住院者的风险增加（HR为0.85[95%CI为0.79 - 0.90]）。与白人种族（HR为1.82[95%CI为1.71 - 1.94]）相比，黑人种族的肾衰竭增加更为明显（HR为4.50[95%CI为2.92 - 6.92]）。在因COVID-19住院的患者中，第一波疫情期间（HR为8.74[95%CI为6.88 - 11.08]）和奥密克戎毒株流行期间（HR为8.36[95%CI为6.81 - 10.27]）的肾衰竭情况没有减弱。
我们观察到因COVID-19住院的患者长期肾脏问题增加，以及显著的种族差异。我们的结果表明，应继续在弱势群体中优化将严重COVID-19的影响降至最低的策略，并且出院后应积极监测肾功能。
国家卫生与保健研究机构。
