Incidence of Chronic Kidney Disease in Survivors of Hospitalization for Moderate to Severe COVID-19: A Prospective Cohort Study
1
Clinic Medicine Department, School of Medicine of the University of São Paulo, São Paulo, Brazil
2
Cardiopneumology Department, School of Medicine of the University of São Paulo, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A96
ABSTRACT
BACKGROUND:
Long COVID encompasses signs and symptoms persisting beyond three months after SARS-CoV-2 infection. During the pandemic, approximately 28% of hospitalized COVID-19 patients developed acute kidney injury (AKI), yet limited evidence exists regarding long-term renal outcomes. Understanding the natural history of kidney disease in COVID-19 survivors is essential for public health planning and clinical follow-up strategies.
METHODS:
This prospective cohort study included adult survivors hospitalized for moderate or severe COVID-19 at HC-FMUSP during 2020. Participants were followed at 6-9 months post-discharge (2021) and at subsequent annual visits (2023-2025). Primary outcomes included de novo chronic kidney disease (CKD), defined as estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m² persisting beyond three months, and CKD progression, characterized by ≥40% eGFR decline from hospital discharge values.
RESULTS:
Of 1,957 survivors screened, 749 met eligibility criteria and attended the first follow-up (mean 6.88 months post-discharge). Mean age was 55.3 years, 47% were female, and 41.5% had obesity. At the first follow-up, 18.8% (141/749) presented reduced eGFR. At the third follow-up (n=432), prevalence remained at 18.5%. Among participants with complete longitudinal data (n=523), 56 exhibited reduced eGFR at both timepoints, consistent with persistent CKD. Incident CKD occurred in 24/439 participants, while substantial eGFR decline (≥40%) occurred in 4.8%.
CONCLUSIONS:
A significant proportion of COVID-19 hospitalization survivors exhibited persistent kidney function impairment during three-year follow-up, highlighting the need for systematic renal monitoring in this population. These findings underscore kidney disease as an important long-term sequela requiring integrated public health approaches for surveillance and management.
Long COVID encompasses signs and symptoms persisting beyond three months after SARS-CoV-2 infection. During the pandemic, approximately 28% of hospitalized COVID-19 patients developed acute kidney injury (AKI), yet limited evidence exists regarding long-term renal outcomes. Understanding the natural history of kidney disease in COVID-19 survivors is essential for public health planning and clinical follow-up strategies.
METHODS:
This prospective cohort study included adult survivors hospitalized for moderate or severe COVID-19 at HC-FMUSP during 2020. Participants were followed at 6-9 months post-discharge (2021) and at subsequent annual visits (2023-2025). Primary outcomes included de novo chronic kidney disease (CKD), defined as estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m² persisting beyond three months, and CKD progression, characterized by ≥40% eGFR decline from hospital discharge values.
RESULTS:
Of 1,957 survivors screened, 749 met eligibility criteria and attended the first follow-up (mean 6.88 months post-discharge). Mean age was 55.3 years, 47% were female, and 41.5% had obesity. At the first follow-up, 18.8% (141/749) presented reduced eGFR. At the third follow-up (n=432), prevalence remained at 18.5%. Among participants with complete longitudinal data (n=523), 56 exhibited reduced eGFR at both timepoints, consistent with persistent CKD. Incident CKD occurred in 24/439 participants, while substantial eGFR decline (≥40%) occurred in 4.8%.
CONCLUSIONS:
A significant proportion of COVID-19 hospitalization survivors exhibited persistent kidney function impairment during three-year follow-up, highlighting the need for systematic renal monitoring in this population. These findings underscore kidney disease as an important long-term sequela requiring integrated public health approaches for surveillance and management.
| eISSN: | 2654-1459 |
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