Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative

Clin J Am Soc Nephrol. 2023 Aug 1;18(8):1006-1018. doi: 10.2215/CJN.0000000000000192. Epub 2023 Jun 5.


Background: AKI is associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19); however, its incidence, geographic distribution, and temporal trends since the start of the pandemic are understudied.

Methods: Electronic health record data were obtained from 53 health systems in the United States in the National COVID Cohort Collaborative. We selected hospitalized adults diagnosed with COVID-19 between March 6, 2020, and January 6, 2022. AKI was determined with serum creatinine and diagnosis codes. Time was divided into 16-week periods (P1-6) and geographical regions into Northeast, Midwest, South, and West. Multivariable models were used to analyze the risk factors for AKI or mortality.

Results: Of a total cohort of 336,473, 129,176 (38%) patients had AKI. Fifty-six thousand three hundred and twenty-two (17%) lacked a diagnosis code but had AKI based on the change in serum creatinine. Similar to patients coded for AKI, these patients had higher mortality compared with those without AKI. 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. Compared with the Midwest, the Northeast, South, and West had higher adjusted odds of AKI in P1. Subsequently, the South and West regions continued to have the highest relative AKI odds. In multivariable models, AKI defined by either serum creatinine or diagnostic code and the severity of AKI was associated with mortality.

Conclusions: The incidence and distribution of COVID-19-associated AKI changed since the first wave of the pandemic in the United States.

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Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Kidney Injury* / diagnosis
  • Adult
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • Creatinine
  • Hospital Mortality
  • Humans
  • Retrospective Studies
  • Risk Factors


  • Creatinine