Study findings updated . AI-assisted evidence summary, not individual medical advice or a clinician endorsement.
Key findings
7.7× kidney failureHazard ratio for kidney failure after a COVID-19 hospital stay vs. matched people
Severe COVID-19 was linked to kidney failure, even in the Omicron era.
In England, adults hospitalized with COVID-19 had 7.7 times the hazard of kidney failure (needing dialysis or a transplant, or near-total loss of function) compared with matched people without COVID-19, and the excess lasted beyond 180 days. The risk was as high in the Omicron wave as in the first wave. People with COVID-19 who were not hospitalized showed no increased risk.
The authors urge kidney checks after any COVID-19 hospital discharge and better prevention of severe illness in vulnerable groups. The link was stronger in Black adults (hazard ratio 4.50) than in white adults (1.82). Observational English records study; risk was highest in the first month, and it cannot show whether COVID-19 itself or severe illness in general caused the damage.
Matched cohort study using NHS England health records (OpenSAFELY) of about 3.5 million adults with COVID-19 and 10 million comparators, 2020 to 2022.
From the study: “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.”
7.7× kidney failure
Mahalingasivam V et al. Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform. The Lancet regional health. Europe. 2025.
From the study: “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]).”
7.7× kidney failure
Mahalingasivam V et al. Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform. The Lancet regional health. Europe. 2025.
From the study: “There was no evidence of increased risk in those not hospitalised (HR 0.85 [95% CI 0.79-0.90]).”
7.7× kidney failure
Mahalingasivam V et al. Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform. The Lancet regional health. Europe. 2025.
3.4% decline per yearAverage yearly drop in kidney filtering after COVID-19, vs. 2.3% after pneumonia
Kidney function fell faster after COVID-19 than after pneumonia.
In Stockholm, adults' kidney filtering rate (eGFR, a blood-test measure of how well kidneys clean the blood) had changed little before infection. After COVID-19 it fell by an average of 3.4% a year, versus 2.3% a year after pneumonia from other causes, including flu. Among people hospitalized for COVID-19, the loss was 5.4% a year.
A few percent a year adds up, and lost kidney function rarely comes back. The authors suggest that people hospitalized for COVID-19 get their kidney function checked more closely in the months afterward. Swedish health records from the pre-Omicron era; only people with blood tests were counted, and the design shows a link, not proof of cause.
Cohort study of about 135,000 adults with COVID-19 and 36,000 with pneumonia in Stockholm, Sweden, using routine blood-test records from 2018 to 2022.
From the study: “After adjustment, the mean annual reduction in eGFR after COVID-19 was 3.4% (95% CI, 3.2%-3.5%), increasing to 5.4% (95% CI, 5.2%-5.6%) among those hospitalized”
3.4% decline per year
Mahalingasivam V et al. Kidney Function Decline After COVID-19 Infection. JAMA network open. 2024.
From the study: “In the pneumonia group, the mean annual reduction in eGFR was 2.3% (95% CI, 2.1%-2.5%) and remained similar after restricting the analysis to those who were hospitalized.”
3.4% decline per year
Mahalingasivam V et al. Kidney Function Decline After COVID-19 Infection. JAMA network open. 2024.
From the study: “Before COVID-19, individuals had, on average, little change in eGFR, regardless of hospitalization status”
3.4% decline per year
Mahalingasivam V et al. Kidney Function Decline After COVID-19 Infection. JAMA network open. 2024.
38% had kidney injuryOf US adults hospitalized with COVID-19 at 53 health systems, 2020 to 2022
Acute kidney injury struck 38% of US adults hospitalized with COVID-19.
Across US health systems, 38% of adults hospitalized with COVID-19 developed acute kidney injury (a sudden drop in kidney function). It was most common in the first months of the pandemic (47%), then settled near 37%. And 17% of all patients had injury visible in blood tests but no diagnosis code; they, too, died more often than patients without injury.
Kidney injury is one of the most common complications of a COVID-19 hospital stay and was tied to higher death rates. Because many cases go unlabeled, patients may never learn it happened, which matters for later kidney checkups. Health-record study through January 2022, largely before Omicron; it shows how often injury occurred, not that COVID-19 alone caused it.
Study of electronic health records from 53 US health systems in the National COVID Cohort Collaborative, covering 336,473 hospitalized adults from March 2020 to January 2022.
From the study: “Of a total cohort of 336,473, 129,176 (38%) patients had AKI.”
38% had kidney injury
Yoo YJ et al. Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative. Clinical journal of the American Society of Nephrology : CJASN. 2023.
From the study: “The incidence of AKI was highest in P1 (47%; 23,097/48,947), lower in P2 (37%; 12,102/32,513), and relatively stable thereafter.”
38% had kidney injury
Yoo YJ et al. Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative. Clinical journal of the American Society of Nephrology : CJASN. 2023.
From the study: “Fifty-six thousand three hundred and twenty-two (17%) lacked a diagnosis code but had AKI based on the change in serum creatinine.”
38% had kidney injury
Yoo YJ et al. Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative. Clinical journal of the American Society of Nephrology : CJASN. 2023.
Paxlovid was linked to fewer hospital stays in people with kidney disease.
Among people with chronic kidney disease or kidney failure who caught COVID-19, 3% of those prescribed Paxlovid (nirmatrelvir-ritonavir) were hospitalized within 30 days, versus 8% of similar untreated patients from the months before the pill was available, a 56% lower adjusted risk. Treated patients also had a lower risk of death within 1 year (hazard ratio 0.37).
The main Paxlovid trials excluded people with advanced kidney disease, so their doctors lacked evidence. Here, treatment was not linked to slower kidney-function decline, but it was linked to fewer hospital stays and deaths. Observational study comparing treated patients with untreated patients from an earlier period, when variants and vaccination differed, so it cannot prove the drug caused the benefit.
Propensity-matched cohort study of 1,679 adults with chronic kidney disease or kidney failure who had COVID-19 in one health care network, 2021 to 2022.
From the study: “Patients who were prescribed nirmatrelvir-ritonavir were significantly less likely to be hospitalized within 30 days”
56% lower hospital risk
Strohbehn IA et al. The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With Kidney Disease: A Propensity Score-Matched Study. Open forum infectious diseases. 2025.
From the study: “29 of 1095 (3%) nirmatrelvir-ritonavir-treated patients and 44 of 584 (8%) historical comparators were hospitalized (adjusted subdistribution hazard ratio [sHR], 0.44; 95% CI, 0.26–0.73; P < .01)”
56% lower hospital risk
Strohbehn IA et al. The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With Kidney Disease: A Propensity Score-Matched Study. Open forum infectious diseases. 2025.
From the study: “Nirmatrelvir-ritonavir use was associated with a decreased risk of death within 1 year (adjusted hazard ratio [aHR], 0.37; 95% CI, 0.21–0.65; P < .01)”
56% lower hospital risk
Strohbehn IA et al. The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With Kidney Disease: A Propensity Score-Matched Study. Open forum infectious diseases. 2025.
70% protectionAgainst hospitalization or death for vaccinated dialysis patients during Delta
Vaccinated dialysis patients had far fewer COVID-19 hospital stays and deaths.
Among US adults on maintenance dialysis (treatment that filters the blood when kidneys fail), full vaccination was linked to 84% protection against COVID-19 hospitalization or death before the Delta variant and 70% protection during the Delta wave, compared with being unvaccinated. Among vaccinated patients, those with lower antibody levels had higher rates of infection and severe illness.
People on dialysis cannot stay home from treatment and often have weak immune systems, yet vaccination still protected most of them from severe illness. Antibody levels may help flag who stays vulnerable. Observational 2021 data from one national dialysis provider, before Omicron; protection may differ against later variants and vaccines.
Retrospective study of about 16,000 adults on maintenance dialysis at Dialysis Clinic Inc, a national US nonprofit provider, February 2021 to January 2022.
From the study: “Between the pre-Delta period and the Delta-dominant period, vaccine effectiveness rates against a severe COVID-19-related event (hospitalization or death) were 84% and 70%, respectively.”
70% protection
Manley HJ et al. SARS-CoV-2 Vaccine Effectiveness and Breakthrough Infections Among Patients Receiving Maintenance Dialysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2023.
From the study: “lower anti-spike IgG levels were associated with higher case rates per 10,000 days and higher adjusted hazard ratios for infection and COVID-19-related hospitalization or death.”
70% protection
Manley HJ et al. SARS-CoV-2 Vaccine Effectiveness and Breakthrough Infections Among Patients Receiving Maintenance Dialysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2023.
1 in 5 needed dialysisOf critically ill US adults with COVID-19, within 14 days of ICU admission
One in five ICU patients with COVID-19 needed dialysis for kidney injury.
In ICUs at US hospitals early in the pandemic, 20.6% of critically ill adults with COVID-19 developed acute kidney injury treated with dialysis (a machine that filters the blood) within 14 days of ICU admission. More than half of them (54.9%) died within 28 days. Of those who survived to go home, one in three still needed dialysis at discharge, and one in six still did 60 days after ICU admission.
Severe COVID-19 can push kidneys to fail so abruptly that a machine must take over, and some survivors leave the hospital still tied to dialysis. Preventing critical illness matters for kidneys as well as lungs. Early-pandemic data from ICUs at 67 US hospitals; with vaccines and better care, later rates may differ.
Multicenter cohort study of 3,099 critically ill adults with COVID-19 admitted to intensive care units at 67 US hospitals early in the pandemic.
From the study: “A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission.”
1 in 5 needed dialysis
Gupta S et al. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. Journal of the American Society of Nephrology : JASN. 2021.
From the study: “Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.”
1 in 5 needed dialysis
Gupta S et al. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. Journal of the American Society of Nephrology : JASN. 2021.
95% higher oddsOdds ratio for acute kidney injury with two APOL1 variants vs. one or none, in hospital
Two APOL1 gene variants were linked to more COVID-19 kidney injury.
Among US veterans with African ancestry hospitalized with COVID-19, those carrying 2 APOL1 risk variants (a gene pattern more common in people of African descent) had 95% higher odds of acute kidney injury than those with 1 or 0 variants, and higher odds of dying. The link held even in people whose kidneys worked normally before (odds ratio 1.93).
Carriers can have normal kidney tests until a severe infection strikes, so this genetic risk is invisible on routine checkups. The finding points to a group for whom avoiding severe COVID-19 may matter most. Observational study of 990 mostly male, older veterans hospitalized early in the pandemic; it shows a link, not proof that the variants cause the injury.
Retrospective genetic cohort of 990 veterans with African ancestry in the Million Veteran Program who were hospitalized with COVID-19, March 2020 to January 2021.
From the study: “Patients categorized as APOL1 high-risk group had significantly higher odds of AKI (adjusted odds ratio [OR], 1.95; 95% CI, 1.27-3.02; P = .002)”
95% higher odds
Hung AM et al. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA internal medicine. 2022.
From the study: “The association with AKI persisted in the subgroup with normal kidney function (OR, 1.93; 95% CI, 1.15-3.26; P = .01).”
95% higher odds
Hung AM et al. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA internal medicine. 2022.
From the study: “The primary exposure was having 2 APOL1 risk variants (RV) (APOL1 high-risk group), compared with having 1 or 0 risk variants (APOL1 low-risk group).”
95% higher odds
Hung AM et al. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA internal medicine. 2022.
17% higher CKD riskHazard ratio, new stage 2+ kidney disease, kids with vs. without COVID-19
Children who had COVID-19 were more likely to develop kidney disease.
Among US children and young people, those who had COVID-19 had a 17% higher risk of new chronic kidney disease (stage 2 or higher, meaning at least mildly reduced function) and a 35% higher risk of stage 3 or higher than peers who tested negative. Those who already had kidney disease, or had kidney injury during the infection, had higher risk of serious declines afterward.
Children usually have milder COVID-19, so kidney effects are easy to miss. Kids with existing kidney disease or kidney injury during infection had the clearest added risk, and the authors call for long-term kidney checks. Observational records study; the added risk is relative, the absolute number of affected children was small, and it cannot prove COVID-19 caused it.
Retrospective cohort of about 1.9 million US children and young adults at 19 health systems in the NIH RECOVER initiative, 2020 to 2023.
From the study: “SARS-CoV-2 infection was associated with higher risk of new-onset CKD stage 2 or higher (HR, 1.17; 95% CI, 1.12-1.22) and CKD stage 3 or higher (HR, 1.35; 95% CI, 1.13-1.62).”
17% higher CKD risk
Li L et al. Kidney Function Following COVID-19 in Children and Adolescents. JAMA network open. 2025.
From the study: “Children with acute-phase AKI had elevated HRs (1.29; 95% CI, 1.21-1.38) at 90 to 179 days for composite outcomes.”
17% higher CKD risk
Li L et al. Kidney Function Following COVID-19 in Children and Adolescents. JAMA network open. 2025.
From the study: “In those with preexisting CKD, COVID-19 was associated with an increased risk of composite kidney events (HR, 1.15; 95% CI, 1.04-1.27) at 28 to 179 days.”
17% higher CKD risk
Li L et al. Kidney Function Following COVID-19 in Children and Adolescents. JAMA network open. 2025.
Study-specific findings. Different populations, treatments and follow-up periods can produce different results.
Vaccine-dose count was associated with hospitalization outcomes in transplant recipients
In an Australian adult kidney transplant cohort during Delta and Omicron BA.1/BA.2 waves, additional vaccine doses were associated with a lower hazard of severe COVID-19 requiring hospitalization.
The underlying dose comparison group and vaccine formulations are not available in this summary, so the hazard magnitude is omitted. A cohort association is not proof that a specified schedule prevented hospitalization.
Study details & original results
Tharmaraj, Dhakshayini et al.. Critical role of vaccination in preventing severe coronavirus disease 2019: perspectives from clinical outcomes in an Australian kidney transplant recipient cohort.. Internal medicine journal. 2026.
Severe COVID-19 requiring hospitalization among adult kidney transplant recipients during the Delta and Omicron BA.1/BA.2 waves
adjusted HR 0.50 per additional vaccine dose 95% CI: 0.40-0.65
Remdesivir associations involved a combined transplant outcome and cardiovascular events
Early remdesivir versus no remdesivir was associated with lower 1-year hazards of transplant failure or death combined, and of cardiovascular events, in adult kidney transplant recipients with symptomatic COVID-19.
For the combined graft-failure/death finding, treatment began within 7 days and continued for at least 3 consecutive days. Both results had weighted adjustment; the combined endpoint includes graft failure or death from any cause, and neither association establishes causation.
Reductions in death alone and long COVID were not established
The weighted analysis did not establish lower all-cause death or long COVID with early remdesivir in kidney transplant recipients with symptomatic COVID-19.
Both uncertainty intervals included no difference. The comparison group for these separate estimates is not available in this summary, so their hazard magnitudes are omitted; neither null establishes equivalence.
Study details & original results
Srisurapanont, Karan et al.. Remdesivir and All-Cause Graft Loss Among Kidney Transplant Recipients With Symptomatic COVID-19.. JAMA network open. 2026.
Among adult kidney transplant recipients with symptomatic COVID-19, early remdesivir initiated within 7 days and administered for at least 3 consecutive days was associated with lower 1-year all-cause graft loss—a composite of graft failure and all-cause mortality—vs no remdesivir after clone-censor-weight adjustment.
HR 0.53 95% CI: 0.31-0.92
Among adult kidney transplant recipients with symptomatic COVID-19, early remdesivir was associated with lower 1-year cardiovascular event risk vs no remdesivir after clone-censor-weight adjustment.
Early remdesivir was not significantly associated with lower all-cause mortality among kidney transplant recipients with symptomatic COVID-19 in the weighted analysis.
HR 0.51 95% CI: 0.24-1.06
Early remdesivir was not significantly associated with lower long-COVID risk among kidney transplant recipients with symptomatic COVID-19 in the weighted analysis.
Dates show when findings were added here, not when papers were published. Study populations and comparisons differ.
Browse all 5 recorded findingsSearch the original results, comparisons and study details.
2 of 2 source groupsFindings stay together with their study.
SOURCE 031 finding
Tharmaraj, Dhakshayini et al.. Critical role of vaccination in preventing severe coronavirus disease 2019: perspectives from clinical outcomes in an Australian kidney transplant recipient cohort.. Internal medicine journal. 2026.
Severe COVID-19 requiring hospitalization among adult kidney transplant recipients during the Delta and Omicron BA.1/BA.2 waves
Added
adjusted HR 0.50 per additional vaccine dose95% CI: 0.40-0.65Source [3]
SOURCE 024 findings
Srisurapanont, Karan et al.. Remdesivir and All-Cause Graft Loss Among Kidney Transplant Recipients With Symptomatic COVID-19.. JAMA network open. 2026.
Among adult kidney transplant recipients with symptomatic COVID-19, early remdesivir initiated within 7 days and administered for at least 3 consecutive days was associated with lower 1-year all-cause graft loss—a composite of graft failure and all-cause mortality—vs no remdesivir after clone-censor-weight adjustment.
Among adult kidney transplant recipients with symptomatic COVID-19, early remdesivir was associated with lower 1-year cardiovascular event risk vs no remdesivir after clone-censor-weight adjustment.
Early remdesivir was not significantly associated with lower all-cause mortality among kidney transplant recipients with symptomatic COVID-19 in the weighted analysis.
Early remdesivir was not significantly associated with lower long-COVID risk among kidney transplant recipients with symptomatic COVID-19 in the weighted analysis.
Browse the 12 original sourcesThe complete bibliography behind this monitor.
[1]
Choi, Yuni et al.. Associations of Pre-Pandemic CKD With Acute and Post-Acute COVID-19: The C4R Study.. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2026.
Srisurapanont, Karan et al.. Remdesivir and All-Cause Graft Loss Among Kidney Transplant Recipients With Symptomatic COVID-19.. JAMA network open. 2026.
Tharmaraj, Dhakshayini et al.. Critical role of vaccination in preventing severe coronavirus disease 2019: perspectives from clinical outcomes in an Australian kidney transplant recipient cohort.. Internal medicine journal. 2026.
Ling, Tsai-Chieh et al.. Humoral and Cellular Immune Responses Following Bivalent SARS-CoV-2 mRNA Vaccines in Patients Undergoing Hemodialysis: A Prospective Cohort Study.. Kidney medicine. 2026.
Mahalingasivam V et al. Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform. The Lancet regional health. Europe. 2025.
Yoo YJ et al. Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative. Clinical journal of the American Society of Nephrology : CJASN. 2023.
Strohbehn IA et al. The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With Kidney Disease: A Propensity Score-Matched Study. Open forum infectious diseases. 2025.
Manley HJ et al. SARS-CoV-2 Vaccine Effectiveness and Breakthrough Infections Among Patients Receiving Maintenance Dialysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2023.
Gupta S et al. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. Journal of the American Society of Nephrology : JASN. 2021.
Hung AM et al. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA internal medicine. 2022.
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