COVID-19 Linked to Kidney Risks in Children and Adolescents

TOPLINE:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was associated with increased risks for various adverse kidney outcomes, including new-onset chronic kidney disease (CKD) and worsening kidney function in patients younger than 21 years. Those with preexisting CKD or acute kidney injury (AKI) faced higher risks for severe adverse outcomes such as dialysis or kidney transplant.

METHODOLOGY:

• Children generally experience milder COVID-19 symptoms than adults, but the long-term effects remain unclear.
• Researchers conducted a retrospective cohort study using data from 19 health institutions in the United States to assess the risks for post–acute kidney injury manifestations of SARS-CoV-2 infection in pediatric patients.
• The study included 1,9srcsrc,146 children and adolescents (mean age, 8.2 years; 49.src% women), of whom 487,378 had COVID-19 and 1,412,768 did not. SARS-CoV-2 infection was confirmed through positive laboratory test results or relevant clinical diagnoses, with the comparison group having negative test results.
• Outcome measures included new-onset CKD stage II or higher (estimated glomerular filtration rate [eGFR] values <9src mL/min/1.73m²) or stage III or higher (eGFR values <6src mL/min/1.73m²) within 28-729 days after infection noted during the second eGFR measurement.
• For patients with preexisting CKD, composite kidney events were examined, including therapeutic interventions such as kidney transplant, long-term kidney dialysis, eGFR decline of at least 5src%, end-stage kidney disease diagnosis, or eGFR ≤ 15 mL/min/1.73m².

TAKEAWAY:

• SARS-CoV-2 infection was associated with a higher risk for new-onset CKD stage II or higher between 28 and 729 days (hazard ratio [HR], 1.17; 95% CI, 1.12-1.22).
• Among patients with the infection, the risk for CKD stage III or higher was also elevated during days 28-729 (HR, 1.35; 95% CI, 1.13-1.62), as well as for CKD stage III or higher without return of eGFR to ≥ 6src mL/min/1.73 m² (HR, 1.35; 95% CI, 1.15-1.59).
• Patients with preexisting CKD had an increased risk for composite kidney outcomes during both 28-179 days (HR, 1.15; 95% CI, 1.src4-1.27) and 18src-729 days (HR, 1.14; 95% CI, 1.src6-1.22). An increased risk was also noted for an eGFR decline of at least 3src%.
• Patients with AKI during acute SARS-CoV-2 infection had increased risks for composite outcomes and an eGFR decline of ≥ 5src% in both the earlier and the later post-acute phases.

IN PRACTICE:

“Results of this study suggest that SARS-CoV-2 infection is associated with an increased risk of adverse kidney outcomes, including new-onset CKD and worsening kidney function, particularly among children with preexisting CKD or acute-phase AKI, underscoring the importance of long-term monitoring for kidney health in children and adolescents affected by COVID-19,” the authors wrote.

SOURCE:

The study was led by Lu Li, MA, of the Center for Health AI and Synthesis of Evidence, University of Pennsylvania, Philadelphia. It was published online in JAMA Network Open.

LIMITATIONS:

The study could not definitively attribute the increased risk in patients with preexisting CKD to COVID-19 alone, as other factors may have contributed. Home testing results that were not visible in electronic health records may have led to misclassification in the control group. Hospital-based testing may have introduced bias, as these patients could have been more severely ill.

DISCLOSURES:

The study was supported by grants from the National Institutes of Health as part of the Researching COVID to Enhance Recovery research initiative. Some authors reported receiving grant support and personal fees from various pharmaceutical companies and institutes. Two authors reported receiving an editorial stipend, and one author reported having a patent with royalties paid.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.