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

Viyaasan Mahalingasivam; Bang Zheng; Kevin Wing; Edward P.K. Parker; Krishnan Bhaskaran; Juan Jesús Carrero; Sandra Jayacodi; Edith Jumbo; Tamanna Miah; Brian Gracey; John Tazare; Shalini Santhakumaran; Rohini Mathur; Ruth E. Costello; Emily Herrett; Qing Wen; Thomas Hartney; Ian J. Douglas; Amelia Green; Louis Fisher; Helen J. Curtis; Alex J. Walker; Brian MacKenna; William J. Hulme; Amir Mehrkar; Sebastian Bacon; Ben Goldacre; Elizabeth Williamson; Dorothea Nitsch; Kathryn E. Mansfield; Laurie Tomlinson; OpenSAFELY Collaborative

doi:10.1016/j.lanepe.2025.101338

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

Viyaasan Mahalingasivam^*, Bang Zheng, Kevin Wing, Edward P.K. Parker, Krishnan Bhaskaran, Juan Jesús Carrero, Sandra Jayacodi, Edith Jumbo, Tamanna Miah, Brian Gracey, John Tazare, Shalini Santhakumaran, Rohini Mathur, Ruth E. Costello, Emily Herrett, Qing Wen, Thomas Hartney, Ian J. Douglas, Amelia Green, Louis FisherHelen J. Curtis, Alex J. Walker, Brian MacKenna, William J. Hulme, Amir Mehrkar, Sebastian Bacon, Ben Goldacre, Elizabeth Williamson, Dorothea Nitsch, Kathryn E. Mansfield, Laurie Tomlinson, OpenSAFELY Collaborative

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
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.

Methods
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.

Findings
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]).

Interpretation
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.

Funding
National Institute for Health and Care Research.

Original language	English
Article number	101338
Number of pages	14
Journal	The Lancet Regional Health - Europe
Volume	55
DOIs	https://doi.org/10.1016/j.lanepe.2025.101338
Publication status	Published - 01 Aug 2025
Externally published	Yes

Keywords

chronic kidney disease
CKD
COVID-19
end-stage kidney disease
end-stage renal disease
ESKD
ESRD
kidney
kidney failure

ASJC Scopus subject areas

Internal Medicine
Oncology
Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.lanepe.2025.101338Licence: CC BY

Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform
Copyright 2025 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 1.23 MBLicence: CC BY

Cite this

Mahalingasivam, V., Zheng, B., Wing, K., Parker, E. P. K., Bhaskaran, K., Carrero, J. J., Jayacodi, S., Jumbo, E., Miah, T., Gracey, B., Tazare, J., Santhakumaran, S., Mathur, R., Costello, R. E., Herrett, E., Wen, Q., Hartney, T., Douglas, I. J., Green, A., ... OpenSAFELY Collaborative (2025). Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform. The Lancet Regional Health - Europe, 55, Article 101338. https://doi.org/10.1016/j.lanepe.2025.101338

@article{c1b1412a7231415592fcbc7324f9d1bd,

title = "Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform",

abstract = "Background 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. Methods 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. Findings 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]). Interpretation 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. Funding National Institute for Health and Care Research. ",

keywords = "chronic kidney disease, CKD, COVID-19, end-stage kidney disease, end-stage renal disease, ESKD, ESRD, kidney, kidney failure",

author = "Viyaasan Mahalingasivam and Bang Zheng and Kevin Wing and Parker, \{Edward P.K.\} and Krishnan Bhaskaran and Carrero, \{Juan Jes{\'u}s\} and Sandra Jayacodi and Edith Jumbo and Tamanna Miah and Brian Gracey and John Tazare and Shalini Santhakumaran and Rohini Mathur and Costello, \{Ruth E.\} and Emily Herrett and Qing Wen and Thomas Hartney and Douglas, \{Ian J.\} and Amelia Green and Louis Fisher and Curtis, \{Helen J.\} and Walker, \{Alex J.\} and Brian MacKenna and Hulme, \{William J.\} and Amir Mehrkar and Sebastian Bacon and Ben Goldacre and Elizabeth Williamson and Dorothea Nitsch and Mansfield, \{Kathryn E.\} and Laurie Tomlinson and \{OpenSAFELY Collaborative\}",

year = "2025",

month = aug,

day = "1",

doi = "10.1016/j.lanepe.2025.101338",

language = "English",

volume = "55",

journal = "The Lancet Regional Health - Europe",

publisher = "Elsevier Ltd",

}

Mahalingasivam, V, Zheng, B, Wing, K, Parker, EPK, Bhaskaran, K, Carrero, JJ, Jayacodi, S, Jumbo, E, Miah, T, Gracey, B, Tazare, J, Santhakumaran, S, Mathur, R, Costello, RE, Herrett, E, Wen, Q, Hartney, T, Douglas, IJ, Green, A, Fisher, L, Curtis, HJ, Walker, AJ, MacKenna, B, Hulme, WJ, Mehrkar, A, Bacon, S, Goldacre, B, Williamson, E, Nitsch, D, Mansfield, KE, Tomlinson, L & OpenSAFELY Collaborative 2025, 'Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform', The Lancet Regional Health - Europe, vol. 55, 101338. https://doi.org/10.1016/j.lanepe.2025.101338

TY - JOUR

T1 - Long-term kidney outcomes after COVID-19: a matched cohort study using the OpenSAFELY platform

AU - Mahalingasivam, Viyaasan

AU - Zheng, Bang

AU - Wing, Kevin

AU - Parker, Edward P.K.

AU - Bhaskaran, Krishnan

AU - Carrero, Juan Jesús

AU - Jayacodi, Sandra

AU - Jumbo, Edith

AU - Miah, Tamanna

AU - Gracey, Brian

AU - Tazare, John

AU - Santhakumaran, Shalini

AU - Mathur, Rohini

AU - Costello, Ruth E.

AU - Herrett, Emily

AU - Wen, Qing

AU - Hartney, Thomas

AU - Douglas, Ian J.

AU - Green, Amelia

AU - Fisher, Louis

AU - Curtis, Helen J.

AU - Walker, Alex J.

AU - MacKenna, Brian

AU - Hulme, William J.

AU - Mehrkar, Amir

AU - Bacon, Sebastian

AU - Goldacre, Ben

AU - Williamson, Elizabeth

AU - Nitsch, Dorothea

AU - Mansfield, Kathryn E.

AU - Tomlinson, Laurie

AU - OpenSAFELY Collaborative

PY - 2025/8/1

Y1 - 2025/8/1

N2 - Background 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. Methods 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. Findings 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]). Interpretation 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. Funding National Institute for Health and Care Research.

AB - Background 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. Methods 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. Findings 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]). Interpretation 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. Funding National Institute for Health and Care Research.

KW - chronic kidney disease

KW - CKD

KW - COVID-19

KW - end-stage kidney disease

KW - end-stage renal disease

KW - ESKD

KW - ESRD

KW - kidney

KW - kidney failure

U2 - 10.1016/j.lanepe.2025.101338

DO - 10.1016/j.lanepe.2025.101338

M3 - Article

AN - SCOPUS:105008538577

VL - 55

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 101338

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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