{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:26:15Z","timestamp":1780485975007,"version":"3.54.1"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,2,6]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate hospital outcomes and their predictors during the pandemic for patients with and without COVID-19, stratified by the presence of acute kidney injury (AKI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective observation study using the Hospital Episodes Statistics database for England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>2\u2009385\u2009337 unique hospital admissions of adult patients from March 2020 to March 2021 in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>COVID-19 cases were identified by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code of U07.1. Patients with suspected COVID-19 (U07.2 code) and patients with end-stage kidney disease on chronic dialysis (N18.6 and Z99.2) were excluded. AKI cases were identified by the ICD10 code. Patients were categorised into four groups based on COVID-19 and AKI diagnoses: Group 1\u2014neither; Group 2\u2014COVID-19 only; Group 3\u2014AKI only; Group 4\u2014both. A multivariable logistic regression model was created with in-hospital mortality as the outcome, including diagnostic groups, demographics, admission methods, comorbidity severity, deprivation index and intensive therapy unit (ITU) admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2\u2009385\u2009337 admissions involving 663\u2009628 patients, 856\u2009544 had AKI (N17 codes) and 1\u2009528\u2009793 did not. Among patients without AKI, there were 1,008,774 admissions among 133,988 individuals without COVID-19 (Group 1) and 520,019 admissions among 256,037 individuals with COVID-19 (Group 2). Among patients with AKI, there were 630,342 admissions among 218,270 individuals without COVID-19 (Group 3) and 226,202 admissions among 55,333 individuals with COVID-19 (Group 4). Patients in group 4 were older (75.4 \u00b1 13.8 years) and had greater length of stay (17.1 \u00b1 17 days) than all other groups. They also had and had a greater proportion of males, ethnic minorities and comorbidities than other groups. Mortality was highest in Group 4 (28.7%) and lowest in Group 1 (1.1%). The increased risk of death persisted after controlling for multiple baseline factors (OR for death vs Group 1: Group 4\u201422.28, Group 2\u20149.67, Group 3\u20146.44). ITU admission was least required in Group 1 (1.2%) and most in Group 4 (10.9%), with mortality at 4.8% versus 47.8%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with COVID-19 and AKI have a high risk of mortality and should be recognised early and provided with optimal support. Planning for future pandemics should ensure adequate critical care and acute dialysis capacity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04579562\">NCT04579562<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2024-095020","type":"journal-article","created":{"date-parts":[[2025,3,16]],"date-time":"2025-03-16T13:15:30Z","timestamp":1742130930000},"page":"e095020","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of COVID-19 with or without acute kidney injury on inpatient mortality in England: a national observational study using administrative data"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct04579562","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04579562","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2528-4436","authenticated-orcid":false,"given":"Nitin V","family":"Kolhe","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"},{"name":"Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Fluck","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9065-212X","authenticated-orcid":false,"given":"Maarten","family":"Taal","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"},{"name":"Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"2025070104242715000_15.3.e095020.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003406","article-title":"Acute kidney injury associated with COVID-19: A retrospective cohort study","volume":"17","author":"Kolhe","year":"2020","journal-title":"PLoS 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