Vaccination Can Reduce Long-Term Kidney Function Decline, Mortality Risk in Hospitalized Patients With COVID-19

Patients with a COVID-19 infection and acute kidney injury (AKI) who were vaccinated against SARS-CoV-2 had increased overall survival and were less likely to require renal replacement therapy (RRT), or dialysis, at discharge, according to results published by lead author Niloofar Nobakht and others in Kidney Medicine.^1,2

COVID-19 vaccination can help fight against other adverse outcomes of COVID-19 disease, including kidney complications. | Image Credit: © myskin - stock.adobe.com

COVID-19 and Poor Kidney Outcomes

COVID-19, the disease caused by SARS-CoV-2, is often associated with poor respiratory-related outcomes such as pneumonia and acute respiratory distress syndrome. This should not rule out analysis of other organs, as COVID-19 is a systemic disease that can impact multiple bodily systems, including the heart, liver, and kidneys. Particularly, AKI is often observed in hospitalized patients with COVID-19 infection.¹

Multiple mechanisms of action may explain the rate of AKI in this population. Some reports detail the interaction between SARS-CoV-2 and the angiotensin-converting enzyme 2 receptor, which is highly expressed in the kidneys. Others suggest that the use of antibiotics and antiviral medications may have potentially related complications.^1,3

Regardless of the specific mechanisms powering these observations, what is clear is that COVID-19 hospitalization is a risk factor for poor kidney outcomes. In pediatric patients with preexisting chronic kidney disease or AKI, infection with SARS-CoV-2 was associated with a heightened risk of adverse postacute kidney outcomes. Further studies, including one conducted by Moledina et al, elucidated the kidney risks patients hospitalized with COVID-19 face, including high inflammatory marker levels, increased in-hospital mortality, and the need for RRT. Most concerning, long-term studies examining these associations are lacking in prevalence.^4,5

Luckily, patients have a powerful tool at their fingertips in the form of COVID-19 vaccination to prevent AKI or other poor kidney outcomes. As of July 2025, over 200 million Americans have received their primary COVID-19 vaccine series, making this an intriguing population to analyze in the context of AKI development. The current authors, citing the high proportion of COVID-19 patients who develop kidney injury, initiated a retrospective cohort study to evaluate renal outcomes in both vaccinated and unvaccinated patients with a COVID-19 infection and AKI.¹

Study Indicates Heightened Rates of AKI, Long-Term Morbidity in Hospitalized COVID-19

The authors utilized a cohort of patients at a large urban academic quaternary care hospital, including those ages 18 years and older with an AKI and laboratory-confirmed COVID-19 infection hospitalized from March 1, 2020, to March 30, 2022. The median duration of follow-up was 232 days and the primary study outcome was in-hospital mortality. In total, 972 patients in the cohort experienced AKI during their hospitalization; 467 (48.0%) were fully vaccinated against COVID-19 and 411 (42.3%) were unvaccinated, and 94 (9.7%) were partially vaccinated and excluded from the study analysis.¹

When examining mortality and hospital stay duration, the investigators found that unvaccinated patients had a meaningfully longer median hospital length of stay when compared with vaccinated patients. Even when a multivariable analysis adjusted for a series of factors, including demographic data, comorbid conditions, and body mass index, the median length of hospital stay remained significantly higher for unvaccinated patients. Unvaccinated patients had significantly higher in-hospital mortality rates in addition to a 2.97 times higher rate of death post-hospitalization.¹

Pharmacists Primed to Increase Vaccination Rates in At-Risk Patients

Fewer vaccinated patients (51; 10.9%) required RRT during their hospitalization compared with unvaccinated patients (65; 15.8%). Accordingly, RRT during hospitalization was linked with an increased hospital length of stay. For long-term RRT burden, patients who were unvaccinated against COVID-19 had 1.58 times higher odds of being discharged on RRT compared with vaccinated patients, the investigators determined in a univariate analysis.²

These results highlight the significance of COVID-19 vaccination beyond strictly preventing direct adverse COVID-19 outcomes, showing the effectiveness of vaccination at reducing the risk of AKI and other kidney dangers. With COVID-19 remaining a prevalent public health threat, patients—especially those with preexisting kidney burdens—should evaluate themselves and their need for COVID-19 vaccination.¹

“The COVID-19 vaccine is an important intervention that can decrease the chances of developing complications from the COVID-19 infection in patients hospitalized with acute kidney injuries,” Nobakht said in a news release accompanying the study results. “It is important for individuals to discuss the benefits of getting vaccinated for COVID-19 with their doctors, as it can decrease the chances of needing dialysis, which can severely affect the quality of life of patients and lead to further complications, including death.”²

Pharmacists are an optimal first choice for patients to consult when inquiring whether receiving a COVID-19 vaccine is the right choice for them. With their front-facing roles and extensive patient knowledge, pharmacists can identify whether a patient at increased risk for AKI or other poor kidney outcomes should receive a COVID-19 vaccination. They can also properly counsel and educate patients on not only the great risks of remaining unvaccinated—especially for those with comorbid conditions—but also on the immense benefits they could receive if they did indeed receive a COVID-19 vaccine.¹

“This study also emphasizes the importance of the need for continued research in understanding how COVID-19 infections affect the kidney and how we should manage and monitor kidney complications from COVID-19 infections to improve patient outcomes,” Nobakht concluded.²

REFERENCES

1. Nobakht N, Jang C, Grogan T, et al. RECOVID: Retrospective Observational Study of Renal Outcomes and Long-Term Mortality in Patients With COVID-19-Associated AKI, A Comparison Between Vaccinated and Unvaccinated Patients. Kidney Med. 2025;7(7):101020. doi:10.1016/j.xkme.2025.101020

2. University of California – Los Angeles Health Sciences. Vaccinated patients hospitalized with COVID-linked acute kidney injury less likely to need dialysis, and more likely to survive, after discharge. EurekAlert! Released June 13, 2025. Accessed July 15, 2025. https://www.eurekalert.org/news-releases/1086198

3. Nobrega Cruz NA, Gonçalves de Oliveira LC, Silva Junior HT, et al. Angiotensin-converting enzyme 2 in the pathogenesis of renal abnormalities observed in COVID-19 patients. Front Physiol. 2021;12. doi:10.3389/fphys.2021.700220

4. McGovern G. COVID-19 associated with higher risk of postacute kidney outcomes in pediatric patients with preexisting CKD. Pharmacy Times. Published April 16, 2025. Accessed July 15, 2025. https://www.pharmacytimes.com/view/covid-19-associated-with-higher-risk-of-postacute-kidney-outcomes-in-pediatric-patients-with-preexisting-ckd

5. Moledina DG, Simonov M, Yamamoto Y, et al. The association of COVID-19 with acute kidney injury independent of severity of illness: A multicenter cohort study. AJKD. 2021;77(4):490-499. doi:10.1053/j.ajkd.2020.12.007