Worsening kidney function observed following SARS-CoV-2 infection in children

1. In this cohort of children and adolescents, there was an association between SARS-CoV-2 infection and an increased risk of developing adverse post-acute kidney outcomes. 

2. In patients with preexisting chronic kidney disease (CKD) who developed an acute kidney injury (AKI) during infection with COVID-19, there was an increased risk of composite kidney outcomes

Evidence Rating Level: 2 (Good) 

Study Rundown: As detailed in previous research, many known conditions result from SARS-CoV-2 infection. The overall term for this is the post-acute sequelae of SARS-CoV-2 (PASC) infection, commonly called long COVID or post-COVID-19 condition. Initially, this syndrome was recognized in adults, however, questions have been raised on how this affects children. Although the prevalence may be similar, the symptoms in pediatrics versus adults are different. The data was analyzed based on whether patients had preexisting chronic kidney disease (CKD) and acute kidney injury (AKI) during the acute phase of the infection to examine the risks of kidney outcomes in pediatrics after infection with SARS-CoV-2. In patients without preexisting kidney disease, exposure to SARS-CoV-2 infection was associated with an increased risk of new-onset CKD. In patients with preexisting CKD, SARS-CoV-2 infection was associated with an increased risk of composite kidney events, such as a decline in estimated glomerular filtration rate (eGFR), end-stage kidney disease, dialysis, or transplant. Patients who had an AKI during infection had an increased risk of composite kidney outcomes in the post-acute phases. The results of this study are similar to prior research following the trend that COVID-19 infection increases the risk of kidney-related outcomes. Patients who tested positive at home with an antigen test might have been mistakenly included in the COVID-19-negative control group if their results were not recorded in the electronic health record (EHR). Despite this, the study was one of the most thorough in examining the long-term effects of SARS-CoV-2 infection on kidney health in children and adolescents. 

Click here to read the study in JAMA Network Open 

Relevant Reading: Post-acute and Chronic Kidney Function Outcomes of COVID-19 in Children and Adolescents: An EHR Cohort Study from the RECOVER Initiative

In-depth [retrospective cohort]: This retrospective cohort study was conducted to investigate kidney outcomes in the pediatric population following infection with COVID-19. Participants were included in this study if they were younger than 21 years old and visited in the time frame of the study. For COVID-19-positive patients, eligibility included a positive COVID-19 test and a diagnosis of COVID-19 or PASC. For negative COVID-19 patients, eligibility included no documented infection with at least one negative COVID-19 test. For CKD outcomes, the date for the first eGFR had to be 28 days after infection, while AKI was defined as a serum creatinine 0.3 mg/d: or 50% greater than baseline, within 28 days of infection. After meeting the criteria, 1,900,146 patients were included (mean [SD] age, 8.2 [6.2] years). Among those, 487,378 had COVID-19, while 1,412,768 did not. In the post-acute phase, the incidence of kidney outcomes was higher in COVID-19-positive patients compared to COVID-19-negative patients. The risk of developing CKD stage 2 or higher (HR, 1.17; 95% CI, 1.12-1.22) and CKD stage 3 or higher (HR, 1.35; 95% CI, 1.13-1.62) was increased in patients without preexisting CKD after infection with SARS-CoV-2. Similarly, for patients with pre-existing CKD, there was an increased risk of composite kidney outcomes (HR, 1.15; 95% CI, 1.04-1.27) in days 28 to 179 following infection with COVID-19. In patients who developed an AKI during infection with COVID-19, there were increased risks for composite kidney outcomes (HR, 1.29; 95% CI, 1.21-1.38) during days 90 to 179 of the post-acute phase. Overall, in this retrospective cohort study, SARS-CoV-2 infection was associated with an increased risk of adverse kidney outcomes in the pediatric population. 

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