Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform.

Publication date: Aug 01, 2025

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.

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