COVID-19: Hospital-acquired vs Community-acquired Acute Kidney Injury

Pavankumar Kamat


August 13, 2021


  • Acute kidney injury (AKI) was reported in more than a quarter of hospitalised patients with COVID-19.

  • Most risk factors for community- and hospital-acquired AKI were common, pointing to a predominantly pre-renal mechanism of injury.

  • Hospital-acquired AKI, but not community-acquired AKI, was a significant risk factor for COVID-19-related mortality.

Why this matters

  • Future studies are warranted to determine the pathophysiology of AKI in patients with COVID-19, particularly regarding thrombotic disease, and to determine whether it differs between community- and hospital-acquired AKI.

Study design

  • Researchers at Salford Royal Hospital in England conducted a retrospective cohort study of 448 patients who tested positive for COVID-19 (March-June 2020).

  • Patients were stratified into community-acquired AKI and hospital-acquired AKI based on the timing of AKI onset.

  • Funding: None.

Key results

  • Of 448 patients with COVID-19, 118 (26.3%) recorded AKI (57 community-acquired; 61 hospital-acquired) during hospital admission.

  • Chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure (SBP) and respiratory rate were significant independent risk factors for community-acquired AKI.

  • CKD, trough SBP, peak heart rate, peak CRP and trough lymphocytes were significant independent risk factors for hospital-acquired AKI.

  • Invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted OR [aOR], 9.1; 95% CI, 3.63-22.80; P<.0001).

  • Patients with AKI vs those without had a higher mortality risk (54.3% vs 29.4%; P<.0001).

  • Hospital-acquired AKI (adjusted HR, 4.64; 95% CI, 2.98-7.23; P<.0001), but not community-acquired AKI, was significantly associated with an increased risk of COVID-19-related mortality.


  • Retrospective design.


Bell JS, James BD, Al-Chalabi S, Sykes L, Kalra PA, Green D. Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients. BMC Nephrol. 2021;22(1):269. doi: 10.1186/s12882-021-02471-2. PMID: 34301204. View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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