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Additional file 4: Supplementary Fig. 3. Age Distribution of Hospitalized Patients with SARS-CoV2 who Experienced AKI within First 7 days of Hospitalization-baseline creatinine estimator MDRD equation removing race. Main figure presents percentage per age bracket who developed acute kidney injury (AKI) among all hospitalized patients and further stratified by severity of illness status. Severe illness is defined as a composite indicator of invasive ventilation, use of vasopressor(s)/inotrope(s), and/or use of extracorporeal membrane oxygenation. Moderate illness is defined as admitted to an intensive care unit but without use of above organ support measures. Mild illness is defined as patient required hospitalization but not in an intensive care unit and without use of above organ support measures. Insert presents the adjusted odds ratio (OR) with 95% confidence intervals (CI) of developing AKI within the first week by age bracket compared to young adults (30���35-year-olds) as the referent category. Adjusted for sex, race/ethnicity, pre-existing hypertension, diabetes mellitus, cancer, chronic kidney disease, and severity of illness. AKI defined per KDIGO guidelines, but baseline creatinine estimator uses modified MDRD equation removing race component for adults (���18 years) and height-independent equation for children (

Additional file 3: Supplementary Fig. 2. Age Distribution of Hospitalized Patients with SARS-CoV2 who Experienced AKI within First 7 days of Hospitalization-baseline creatinine estimator FAS equation. Main figure presents percentage per age bracket who developed acute kidney injury (AKI) among all hospitalized patients and further stratified by severity of illness status. Severe illness is defined as a composite indicator of invasive ventilation, use of vasopressor(s)/inotrope(s), and/or use of extracorporeal membrane oxygenation. Moderate illness is defined as admitted to an intensive care unit but without use of above organ support measures. Mild illness is defined as patient required hospitalization but not in an intensive care unit and without use of above organ support measures. Insert presents the adjusted odds ratio (OR) with 95% confidence intervals (CI) of developing AKI within the first week by age bracket compared to young adults (30���35-year-olds) as the referent category. Adjusted for sex, race/ethnicity, pre-existing hypertension, diabetes mellitus, cancer, chronic kidney disease, and severity of illness. AKI defined per KDIGO guidelines, but baseline creatinine estimator uses full-age spectrum (FAS) equation for all participants.

Additional file 1: Supplementary Table 1. Initial Hospital-related Associations with SARS-CoV2 -related AKI. These therapies or complications occur within the first 7 days of hospitalization when SARS-CoV2-related AKI is defined. Data presented as number (column percentiles), except where specified. ACE-I = angiotensin-converting enzyme-inhibitors; AKI = acute kidney injury; ARB = angiotensin receptor blockers; IVIG = intravenous immunoglobulin; NSAID = non-steroidal anti-inflammatory drugs; PRISM = Pediatric Risk of Mortality Score; SOFA = Sequential Organ Failure Assessment. aInitial PRISM score missing for 497 pediatric patients. Baseline SOFA score missing for 2741 adult patients; maximum SOFA score missing for 2016 adult patients.

Additional file 5: Supplementary Fig. 4. Age Distribution of Hospitalized Patients with SARS-CoV2 who Experienced AKI within First 7 days of Hospitalization-baseline creatinine estimator as minimum serum creatinine. Main figure presents percentage per age bracket who developed acute kidney injury (AKI) among all hospitalized patients and further stratified by severity of illness status. Severe illness is defined as a composite indicator of invasive ventilation, use of vasopressor(s)/inotrope(s), and/or use of extracorporeal membrane oxygenation. Moderate illness is defined as admitted to an intensive care unit but without use of above organ support measures. Mild illness is defined as patient required hospitalization but not in an intensive care unit and without use of above organ support measures. Insert presents the adjusted odds ratio (OR) with 95% confidence intervals (CI) of developing AKI within the first week by age bracket compared to young adults (30���35-year-olds) as the referent category. Adjusted for sex, race/ethnicity, pre-existing hypertension, diabetes mellitus, cancer, chronic kidney disease, and severity of illness. AKI defined per KDIGO guidelines, but baseline creatinine estimator uses minimum serum creatinine value within first 7 days of hospitalization for all participants.

Additional file 2: Supplementary Fig. 1. Age Distribution of Hospitalized Patients with SARS-CoV2 who Experienced AKI within First 7 days of Hospitalization-different baseline creatinine estimators. Main figure presents percentage per age bracket who developed acute kidney injury (AKI) among all hospitalized patients. The original AKI definition (blue) assumes a baseline creatinine based on KDIGO guidelines for adults (eGFR 75 ml/min/1.73m2 and back calculates using MDRD equation) and common pediatric definitions assuming an eGFR of 120 ml/min/1.73m2 and back calculating using height-independent equation, except for patients with CKD when minimum serum creatinine during first 7 days of hospitalization is assumed to be their baseline creatinine value. Orange line assumes that the minimum creatinine during the first 7 days of hospitalization is the baseline creatinine for all participants. Gray line uses the KDIGO guidelines but back calculates the baseline creatinine for all participants using the FAS equation. Yellow line uses the original definition but uses the MDRD equation minus the race variable. Abbreviations: AKI = acute kidney injury, CKD = chronic kidney disease, eGFR = estimated glomerular filtration rate, FAS = full age spectrum, KDIGO=Kidney Disease Improving Global Outcomes, MDRD = modification of diet in renal disease.

Background Hospitalized patients with SARS-CoV2 develop acute kidney injury (AKI) frequently, yet gaps remain in understanding why adults seem to have higher rates compared to children. Our objectives were to evaluate the epidemiology of SARS-CoV2-related AKI across the age spectrum and determine if known risk factors such as illness severity contribute to its pattern. Methods Secondary analysis of ongoing prospective international cohort registry. AKI was defined by KDIGO-creatinine only criteria. Log-linear, logistic and generalized estimating equations assessed odds ratios (OR), risk differences (RD), and 95% confidence intervals (CIs) for AKI and mortality adjusting for sex, pre-existing comorbidities, race/ethnicity, illness severity, and clustering within centers. Sensitivity analyses assessed different baseline creatinine estimators. Results Overall, among 6874 hospitalized patients, 39.6% (n = 2719) developed AKI. There was a bimodal distribution of AKI by age with peaks in older age (≥60 years) and middle childhood (5–15 years), which persisted despite controlling for illness severity, pre-existing comorbidities, or different baseline creatinine estimators. For example, the adjusted OR of developing AKI among hospitalized patients with SARS-CoV2 was 2.74 (95% CI 1.66–4.56) for 10–15-year-olds compared to 30–35-year-olds and similarly was 2.31 (95% CI 1.71–3.12) for 70–75-year-olds, while adjusted OR dropped to 1.39 (95% CI 0.97–2.00) for 40–45-year-olds compared to 30–35-year-olds. Conclusions SARS-CoV2-related AKI is common with a bimodal age distribution that is not fully explained by known risk factors or confounders. As the pandemic turns to disproportionately impacting younger individuals, this deserves further investigation as the presence of AKI and SARS-CoV2 infection increases hospital mortality risk.

Additional file 6: Supplementary Fig. 5. Age Distribution of Hospitalized Patients with SARS-CoV2 who Experienced AKI within First 7 days of Hospitalization Stratified by U.S. versus non-U.S. Hospital. Presents percentage of hospitalized patients who developed acute kidney injury (AKI) among all hospitalized patients and further stratified by hospital center based in the United States versus not in the United States. AKI defined per KDIGO guidelines.