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This study describes the incidence, evolution and prognosis of acute kidney injury (AKI) in critical COVID-19 during the first pandemic wave. We performed a prospective, observational, multicenter study of confirmed COVID-19 patients admitted to 19 intensive care units (ICUs) in Catalonia (Spain). Data regarding demographics, comorbidities, drug and medical treatment, physiological and laboratory results, AKI development, need for renal replacement therapy (RRT) and clinical outcomes were collected. Descriptive statistics and logistic regression analysis for AKI development and mortality were used. A total of 1,642 patients were enrolled (mean age 63 (15.95) years, 67.5% male). Mechanical ventilation (MV) was required for 80.8% and 64.4% of these patients, who were in prone position, while 67.7% received vasopressors. AKI at ICU admission was 28.4% and increased to 40.1% during ICU stay. A total of 172 (10.9%) patients required RRT, which represents 27.8% of the patients who developed AKI. AKI was more frequent in severe acute respiratory distress syndrome (ARDS) ARDS patients (68% vs 53.6%, pConclusions There is a high incidence of AKI in critically ill patients with COVID-19 disease and it is associated with higher mortality, increased organ failure, nosocomial infections and prolonged ICU stay.本研究聚焦新冠大流行第一波期间，重症新冠患者急性肾损伤（acute kidney injury, AKI）的发生率、演变过程及预后情况。我们在西班牙加泰罗尼亚地区的19家重症监护病房（intensive care units, ICU）开展了一项前瞻性、观察性多中心研究，纳入经实验室确诊的新冠住院患者。研究收集了患者的人口学特征、合并症、用药与诊疗方案、生理指标及实验室检测结果、急性肾损伤发生情况、肾脏替代治疗（renal replacement therapy, RRT）需求以及临床转归相关数据。研究采用描述性统计方法，并针对急性肾损伤发生与死亡率开展逻辑回归分析。本研究共纳入1642例患者，平均年龄为63（标准差15.95）岁，男性占比67.5%。其中80.8%与64.4%的患者需接受机械通气（mechanical ventilation, MV）并采取俯卧位，另有67.7%的患者使用血管升压药物。患者入住重症监护病房时的急性肾损伤发生率为28.4%，住院期间该比例升至40.1%。共计172例（占总入组患者的10.9%）患者需要接受肾脏替代治疗，占发生急性肾损伤患者总数的27.8%。重症急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）患者的急性肾损伤发生率更高（68% vs 53.6%，p）结论：重症新冠患者的急性肾损伤发生率较高，且该病症与更高的死亡率、多器官功能衰竭加重、医院获得性感染及重症监护病房住院时间延长显著相关。