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Post-acute and Chronic Kidney Function Outcomes of COVID-19 in Children and Adolescents: An EHR Cohort Study from the
Lu Li1,2, Ting Zhou1, Yiwen Lu1,2
1The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA.
Insights
Children and adolescents with COVID-19 face increased risks for adverse kidney outcomes, including chronic kidney disease (CKD) and acute kidney injury (AKI). This risk is elevated for those with pre-existing kidney conditions or prior AKI.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Epidemiology
Background:
- The long-term kidney health implications of SARS-CoV-2 infection in children remain incompletely understood.
- Previous studies have primarily focused on adult populations, leaving a gap in knowledge regarding pediatric adverse kidney outcomes post-COVID-19.
Purpose of the Study:
- To investigate the risks of post-acute and chronic adverse kidney outcomes following SARS-CoV-2 infection in the pediatric population.
- To stratify risks based on pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) during the acute phase of infection.
Main Methods:
- Retrospective cohort study utilizing data from the RECOVER program.
- Inclusion of 1,864,637 children and adolescents (<21 years) from 19 US institutions with at least six months of follow-up (March 2020 - May 2023).
- Stratification into three groups: pre-existing CKD, AKI during acute SARS-CoV-2, and no pre-existing CKD/AKI; analysis of defined adverse kidney outcomes in post-acute and chronic phases.
Main Results:
- Patients with COVID-19 exhibited a higher risk of adverse kidney outcomes across all strata compared to the non-infected group.
- In children without pre-existing CKD, post-acute infection (28-365 days) increased risks for CKD stage 2+ (HR 1.20) and CKD stage 3+ (HR 1.35).
- Children with pre-existing CKD or prior AKI faced heightened risks of kidney function decline, End Stage Kidney Disease, dialysis, or transplant post-infection.
Conclusions:
- SARS-CoV-2 infection poses a significant risk for adverse kidney outcomes in children and adolescents.
- The risk is particularly pronounced in those with pre-existing CKD or who develop AKI during the acute phase of infection.
- Long-term kidney monitoring is crucial for pediatric COVID-19 survivors, especially those with underlying kidney vulnerabilities.
Abstract:
We investigated the risks of post-acute and chronic adverse kidney outcomes of SARS-CoV-2 infection in the pediatric population via a retrospective cohort study using data from the RECOVER program. We included 1,864,637 children and adolescents under 21 from 19 children's hospitals and health institutions in the US with at least six months of follow-up time between March 2020 and May 2023. We divided the patients into three strata: patients with pre-existing chronic kidney disease (CKD), patients with acute kidney injury (AKI) during the acute phase (within 28 days) of SARS-CoV-2 infection, and patients without pre-existing CKD or AKI. We defined a set of adverse kidney outcomes for each stratum and examined the outcomes within the post-acute and chronic phases after SARS-CoV-2 infection. In each stratum, compared with the non-infected group, patients with COVID-19 had a higher risk of adverse kidney outcomes. For patients without pre-existing CKD, there were increased risks of CKD stage 2+ (HR 1.20; 95% CI: 1.13-1.28) and CKD stage 3+ (HR 1.35; 95% CI: 1.15-1.59) during the post-acute phase (28 days to 365 days) after SARS-CoV-2 infection. Within the post-acute phase of SARS-CoV-2 infection, children and adolescents with pre-existing CKD and those who experienced AKI were at increased risk of progression to a composite outcome defined by at least 50% decline in estimated glomerular filtration rate (eGFR), eGFR <15 mL/min/1.73m2, End Stage Kidney Disease diagnosis, dialysis, or transplant.
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