text: Kidney Outcomes in Long COVID COVID 19 is associated with increased risk of post acute sequelae involving pulmonary and extrapulmonary organ systems referred to as long COVID However a detailed assessment of kidney outcomes in long COVID is not yet available We built a cohort of 1 726 683 US Veterans identified from March 1 2020 to March 15 2021 including 89 216 patients who were 30 day survivors of COVID 19 and 1 637 467 non infected controls We examined risks of AKI eGFR decline ESKD and major adverse kidney events MAKE MAKE was defined as eGFR decline 50 ESKD or all cause mortality We used inverse probability weighted survival regression adjusting for predefined demographic and health characteristics and algorithmically selected high dimensional covariates including diagnoses medications and laboratory tests Linear mixed models characterized intra individual eGFR trajectory Beyond the acute illness 30 day survivors of COVID 19 exhibited a higher risk of AKI aHR 1 94 95 CI 1 86 to 2 04 eGFR decline 30 aHR 1 25 95 CI 1 14 to 1 37 eGFR decline 40 aHR 1 44 95 CI 1 37 to 1 51 eGFR decline 50 aHR 1 62 95 CI 1 51 to 1 74 ESKD aHR 2 96 95 CI 2 49 to 3 51 and MAKE aHR 1 66 95 CI 1 58 to 1 74 Increase in risks of post acute kidney outcomes was graded according to the severity of the acute infection whether patients were non hospitalized hospitalized or admitted to intensive care Compared with non infected controls 30 day survivors of COVID 19 exhibited excess eGFR decline 95 CI of 3 26 3 58 to 2 94 5 20 6 24 to 4 16 and 7 69 8 27 to 7 12 ml min per 1 73 m sup 2 sup per year respectively in non hospitalized hospitalized and those admitted to intensive care during the acute phase of COVID 19 infection Patients who survived COVID 19 exhibited increased risk of kidney outcomes in the post acute phase of the disease Post acute COVID 19 care should include attention to kidney disease 