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COVID-19 Associated With Higher Risk of Postacute Kidney Outcomes in Pediatric Patients With Preexisting CKD
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Key Takeaways
- SARS-CoV-2 infection increases risk of adverse kidney outcomes in children, especially with preexisting CKD or AKI.
- Study involved over 1.9 million pediatric patients, highlighting new-onset CKD and composite kidney events post-COVID-19.
At 28 to 179 days, COVID-19 infection in patients with preexisting chronic kidney disease (CKD) was associated with an increased risk of composite kidney events.
SARS-CoV-2 infection was associated with a higher risk of adverse postacute kidney outcomes, notably in patients with preexisting chronic kidney disease (CKD) or acute kidney injury (AKI), according to authors of a study published in JAMA Network Open. These findings emphasize a need for attentive long-term monitoring in this patient population.
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Prior research has demonstrated that postacute SARS-CoV-2 infection, also known as “long COVID,” can have detrimental effects on the health of those who tested positive for the infection. These effects are defined as “new, returning, or ongoing health problems present at least 4 weeks after infection” by the CDC and National Institutes of Health (NIH). Although this was initially recognized in adults, it was unclear how the pediatric population may be affected by long COVID. Additionally, it is unclear how it affects the risk of the onset of long-term kidney complications. For this study, the investigators assessed whether SARS-CoV-2 infection is associated with an increased risk of postacute kidney outcomes among pediatric patients, including those who have preexisting CKD or AKI.
This retrospective cohort study utilized data from 19 health institutions in the NIH Researching COVID to Enhance Recovery (RECOVER) initiative from March 1, 2020, to May 1, 2023. A total of 1,900,146 pediatric patients (children and adolescents) younger than 21 years (mean age: 8.2 years). Patients had at least 1 baseline visit (24 months to 7 days prior to the index date) and at least 1 follow-up visit (28-179 days after the index date).
SARS-CoV-2 infections were determined by positive laboratory test results (polymerase chain reaction, antigen, or serologic) or relevant clinical diagnoses. Additionally, a comparison group that included children with documented negative test results and no history of SARS-CoV-2 infection was enrolled (n = 1,412,768). Outcomes included the following: new-onset CKD stage 2 or higher, or CKD stage 3 or higher among patients without preexisting CKD; composite kidney events, including a decline of at least 50% in estimated glomerular filtration rate (eGFR), eGFR of 15 mL/min/1.73 m2 or less, dialysis, transplant, or end-stage kidney disease diagnosis; and at least 30%, 40%, or 50% eGFR decline among those with preexisting CKD or acute-phase AKI.
Most of the enrolled patients were male (n = 969,937; 51.0%) and non-Hispanic White (n = 852,723; 44.9%). A range of comorbidities was also represented.
The investigators observed that SARS-CoV-2 infection was associated with a higher risk of new-onset 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). Additionally, COVID-19 was associated with an increased risk of composite kidney events (HR, 1.15; 95% CI, 1.04-1.27) at 28 to 179 days in patients with preexisting CKD. There was an increase in risk found for an eGFR decline of at least 30% between days 28 and 179, with an HR of about 1.14 (95% CI, 1.03-1.25), and for an eGFR decline of at least 30% between days 180 and 729, the HR was 1.13 (95% CI, 1.05-1.20). These findings indicate a heightened risk for kidney function decline in individuals with preexisting CKD following COVID-19 infection, according to the authors.
For children who had acute-phase AKI, they demonstrated elevated HRs (1.29; 95% CI, 1.21-1.38) at 90 to 179 days for composite outcomes and were higher (HR, 1.33; 95% CI, 1.21-1.47) for days 180 to 729. There was also an increased risk for an eGFR decline of at least 50% in both the earlier postacute phase (HR, 1.47; 95% CI, 1.06-2.03) and the later postacute phase (HR, 1.42; 95% CI, 1.31-1.55). An increased risk for an eGFR decline of at least 40% was observed in both the earlier postacute phase (HR, 1.24; 95% CI, 1.10-1.41) and the later postacute phase (HR 1.41; 95% CI, 1.21-1.63). Further, an increased risk was observed for an eGFR decline of at least 30% at an HR of 1.27 (95% CI, 1.20-1.36) for days 28 to 179 and remained high at 1.31 (95% CI, 1.20-1.43) for days 180 to 729. For these reasons, the authors concluded there was an increased risk for adverse kidney outcomes in patients with AKI following COVID-19 infection.
Based on these data, the investigators determined there was an increase in the risk of various kidney outcomes associated with COVID-19 infection. This heightened risk includes a new onset of mild-to-moderate CKD during the postacute phase of the infection, and for patients with preexisting CKD who experienced AKI during the acute phase, there was an observed increased risk of a composite outcome of at least 50% eGFR decline, eGFR of 15 mL/min/1.73 m2 or less, dialysis, kidney transplant, or ESKD diagnosis. The authors emphasized that future studies are needed to evaluate the cumulative impact of recurrent infections on kidney function.
