COVID-19 in Children with Chronic Kidney Disease; Does it Differ Much?

Abstract

Background COVID-19 is known to have a mild course in children, however more data on pediatric chronic kidney disease (CKD) is needed. We aimed to assess the incidence and severity of COVID-19 in pediatric CKD patients.

Methods A questionnaire including demographics, COVID-19 history, symptoms, and vaccination status was applied to patients with CKD. We also retrospectively reviewed the presentation and outcomes of SARS-CoV-2 infection in this patient group from March 2020 to December 2021.

Results 220 patients were included, 48 were found to have experienced COVID-19. There was no significant difference regarding age, gender, underlying kidney disease, CKD stage, dialysis status, type or number of immunosuppressive medications, and glomerular filtration rate between patients with and without COVID-19. Most were infected by a household member (43.8%) and during outpatient or inpatient care (18.8%). Four (8.3%) were asymptomatic, and 43 (89.6%) had mild infection. Severe COVID-19 was observed in only one patient. Eleven (22.9%) patients with COVID-19 were previously vaccinated. Acute kidney injury was detected in 4 (8.3%); as stage 1 in all. Median follow-up after COVID-19 was 4.6 months. All patients fully recovered, and no renal disease flare or death was observed.

Conclusions Although the vaccination rate was low in our cohort, the majority of the children with COVID-19 showed a mild course. Along with the vaccination, general precautions seemed to be successful for this population.

Zusammenfassung

Hintergrund Es ist bekannt, dass COVID-19 in Kindern einen milden Verlauf hat, aber wenn es um pädiatrischen chronischen Nierenerkrankung (CNE) geht, es gibt wenig data. Unser Ziel war es, die Inzidenz und den Schweregrad von COVID-19 bei pädiatrischen CNE-Patienten zu beurteilen.

Methoden Ein Fragebogen, der Demografie, COVID-19-Anamnese, Symptome und Impfstatus umfasste, wurde bei Patienten mit chronischer Nierenerkrankung angewendet. Wir haben auch retrospektiv das Erscheinungsbild und die Ergebnisse einer SARS-CoV-2-Infektion in dieser Patientengruppe von März 2020 bis Dezember 2021 überprüft.

Ergebnisse 220 Patienten wurden eingeschlossen, bei 48 wurde festgestellt, dass sie an COVID-19 erkrankt waren. Es gab keinen signifikanten Unterschied hinsichtlich Alter, Geschlecht, zugrunde liegender Nierenerkrankung, CNE-Stadium, Dialysestatus, Art oder Anzahl der immunsuppressiven Medikamente und glomerulärer Filtrationsrate zwischen Patienten mit und ohne COVID-19. Die meisten wurden durch ein Haushaltsmitglied (43,8%) und während der ambulanten oder stationären Behandlung (18,8%) infiziert. Vier (8,3%) waren asymptomatisch, 43 (89,6%) hatten eine leichte Infektion. Nur bei einem Patienten wurde ein schwerer COVID-19-Verlauf beobachtet. Elf (22,9%) Patienten mit COVID-19 waren zuvor geimpft. Eine akute Nierenschädigung wurde bei 4 (8,3%) festgestellt; insgesamt als Stufe 1. Die mittlere Nachbeobachtungszeit nach COVID-19 betrug 4,6 Monate. Alle Patienten erholten sich vollständig, es wurde kein Aufflammen der Nierenerkrankung oder Tod beobachtet.

Schlussfolgerungen Obwohl die Impfrate in unserer Kohorte niedrig war, zeigte die Mehrheit der Kinder mit COVID-19 einen milden Verlauf. Neben der Impfung schienen auch allgemeine Vorsichtsmaßnahmen für diese Bevölkerungsgruppe erfolgreich zu sein.

Key words

COVID-19 - CKD - nephrotic syndrome - renal transplantation - immunosupression

Schlüsselwörter

COVID-19 - CNE - nephrotisches Syndrome - Nierentransplantation - Immunsuppression

Publication History

Article published online:
15 January 2024

• References

• 1 Williamson EJ, Walker AJ, Bhaskaran K. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020; 584: 430-436 DOI: 10.1038/s41586-020-2521-4.
• 2 Richardson S, Hirsch JS, Narasimhan M. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. Jama 2020; 323: 2052-2059 DOI: 10.1001/jama.2020.6775.
• 3 Dong Y, Mo X, Hu Y. et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020; 145 DOI: 10.1542/peds.2020-0702.
• 4 DeBiasi RL, Song X, Delaney M. et al. Severe Coronavirus Disease-2019 in Children and Young Adults in the Washington, DC, Metropolitan Region. The Journal of Pediatrics 2020; 223: 199-203.e191 DOI: 10.1016/j.jpeds.2020.05.007.
• 5 Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19. The Journal of Infection 2020; 80: 607-613 DOI: 10.1016/j.jinf.2020.03.037.
• 6 Jager KJ, Kramer A, Chesnaye NC. et al. Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe. Kidney International 2020; 98: 1540-1548 DOI: 10.1016/j.kint.2020.09.006.
• 7 Vasconcelos MA, Mendonça ACQ, Colosimo EA. et al. Outcomes and risk factors for death among hospitalized children and adolescents with kidney diseases and COVID-19: an analysis of a nationwide database. Pediatric Nephrology 2023; 38: 181-191 DOI: 10.1007/s00467-022-05588-0.
• 8 Krishnasamy S, Mantan M, Mishra K. et al. SARS-CoV-2 infection in children with chronic kidney disease. Pediatric Nephrology 2022; 37: 849-857 DOI: 10.1007/s00467-021-05218-1.
• 9 Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Critical Care 2013; 17: 204 DOI: 10.1186/cc11454.
• 10 Schwartz GJ, Muñoz A, Schneider MF. et al. New equations to estimate GFR in children with CKD. Journal of the American Society of Nephrology : JASN 2009; 20: 629-637 DOI: 10.1681/asn.2008030287.
• 11 https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum. Acsess date:21/11/2022
• 12 ERA-EDTA Council and the ERACODA Working Group. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrology, Dialysis, Transplantation 2021; 36: 87-94 DOI: 10.1093/ndt/gfaa314.
• 13 Chung EYM, Palmer SC, Natale P. et al. Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis. American Journal of Kidney Diseases 2021; 78: 804-815 DOI: 10.1053/j.ajkd.2021.07.00.
• 14 Akchurin O, Meza K, Biswas S. et al. COVID-19 in Patients with CKD in New York City. Kidney360 2021; 2: 63-70 DOI: 10.34067/kid.0004142020.
• 15 Marlais M, Wlodkowski T, Al-Akash S. et al. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Archives of Disease in Childhood 2020; 106: 798-801 DOI: 10.1136/archdischild-2020-320616.
• 16 Plumb L, Benoy-Deeney F, Casula A. et al. COVID-19 in children with chronic kidney disease: findings from the UK renal registry. Archives of Disease in Childhood 2021; 106: e16 DOI: 10.1136/archdischild-2020-319903.
• 17 Varnell C, Harshman LA, Smith L. et al. COVID-19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative. American Journal of Transplantation 2021; 21: 2740-2748 DOI: 10.1111/ajt.16501.
• 18 Marlais M, Wlodkowski T, Vivarelli M. et al. The severity of COVID-19 in children on immunosuppressive medication. The Lancet Child & Adolescent Health 2020; 4: e17-e18 DOI: 10.1016/s2352-4642(20)30145-0.
• 19 Weinbrand-Goichberg J, Ben Shalom E, Rinat C. et al. COVID-19 in children and young adults with kidney disease: risk factors, clinical features and serological response. Journal of Nephrology 2022; 35: 121-129 DOI: 10.1007/s40620-021-01171-2.
• 20 Melgosa M, Madrid A, Alvárez O. et al. SARS-CoV-2 infection in Spanish children with chronic kidney pathologies. Pediatric Nephrology 2020; 35: 1521-1524 DOI: 10.1007/s00467-020-04597-1.
• 21 Varnell C, Harshman LA, Liu C. et al. COVID-19 in pediatric kidney transplantation: a follow-up report of the Improving Renal Outcomes Collaborative. Pediatric Nephrology 2022; 1-11 DOI: 10.1007/s00467-022-05570-w.
• 22 Nachega JB, Sam-Agudu NA, Machekano RN. et al. Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries. JAMA Pediatrics 2022; 176: e216436 DOI: 10.1001/jamapediatrics.2021.6436.
• 23 Nachega JB, Ishoso DK, Otokoye JO. et al. Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo. The American Journal of Tropical Medicine and Hygiene 2020; 103: 2419-2428 DOI: 10.4269/ajtmh.20-1240.
• 24 Canpolat N, Yıldırım ZY, Yıldız N. et al. COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation. European Journal of Pediatrics 2022; 181: 117-123 DOI: 10.1007/s00431-021-04191-z.
• 25 Chan L, Chaudhary K, Saha A. et al. AKI in Hospitalized Patients with COVID-19. Journal of the American Society of Nephrology: JASN 2021; 32: 151-160 DOI: 10.1681/asn.2020050615.
• 26 Kant S, Menez SP, Hanouneh M. et al. The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation. BMC Nephrology 2020; 21: 449 DOI: 10.1186/s12882-020-02112-0.
• 27 Kronbichler A, Gauckler P, Windpessl M. et al. COVID-19: implications for immunosuppression in kidney disease and transplantation. Nature Reviews Nephrology 2020; 16: 365-367 DOI: 10.1038/s41581-020-0305-6.
• 28 Angeletti A, Drovandi S, Sanguineri F. et al. COVID-19 in Children with Nephrotic Syndrome on Anti-CD20 Chronic Immunosuppression. Clinical Journal of the American Society of Nephrology : CJASN 2020; 15: 1494-1495 DOI: 10.2215/cjn.06400420.
• 29 Sinha R, Marlais M, Sarkar S. et al. Impact of COVID-19 pandemic on use of rituximab among children with difficult nephrotic syndrome. Pediatric Research 2021; 1-3 DOI: 10.1038/s41390-021-01744-8.