COVID-19 in children with chronic kidney disease: findings from the UK renal registry

Plumb, Lucy; Benoy-Deeney, Fran; Casula, Anna; Braddon, Fiona; Tse, Yincent; Inward, Carol; Marks, Stephen D.; Steenkamp, Retha; Mu, James; Nitsch, Dorothea

doi:10.1136/archdischild-2020-319903

Cited by 19 publications

(21 citation statements)

References 4 publications

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“…Children are most likely to develop asymptomatic or mild disease due to COVID-19 [ 15 , 20 ]; however, selected pediatric populations with high rates of comorbidities may have a considerable clinical course [ 21 ]. Previous reports demonstrated that most children with CKD or a functioning KTx had a mild or moderate illness of COVID-19 [ 9 – 12 , 19 , 22 ]. The IROC registry reported that 37% of KTx children were asymptomatic [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to adults, most evidence to date suggests that children with advanced stages of CKD, dialysis, or a KTx are not at high risk for COVID-19 and generally have a mild disease course [ 9 – 12 ]. Despite the growing data on COVID-19, it is still of great importance to collect national and international data on this challenging disease from both children and adults [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation

et al. 2021

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The study aims to present the incidence of COVID-19 in pediatric patients undergoing renal replacement therapy (RRT) and to compare the severity and outcomes of the disease between the dialysis and kidney transplant (KTx) groups. This multicenter observational study was conducted between 1 April and 31 December 2020 in Istanbul. Members of the Istanbul branch of the Turkish Pediatric Nephrology Association were asked to report all confirmed cases of COVID-19 who were on RRT, as well as the number of prevalent RRT patients under the age of 20. A total of 46 confirmed cases of COVID-19 were reported from 12 centers, of which 17 were dialysis patients, and 29 were KTx recipients. Thus, the incidence rate of COVID-19 was 9.3% among dialysis patients and 9.2% among KTx recipients over a 9-month period in Istanbul. Twelve KTx recipients and three dialysis patients were asymptomatic ( p = 0.12). Most of the symptomatic patients in both the dialysis and KTx groups had a mild respiratory illness. Only two patients, one in each group, experienced a severe disease course, and only one hemodialysis patient had a critical illness that required mechanical ventilation. In the entire cohort, one hemodialysis patient with multiple comorbidities died. Conclusion : While most cases are asymptomatic or have a mild disease course, pediatric patients undergoing dialysis and a kidney transplant are at increased risk for COVID-19. What is Known: • In adult population, both dialysis patients and kidney transplant recipients are at increased risk for severe illness of COVID-19 and have higher mortality rate. • Children with kidney transplantation are not at increased risk for COVID-19 and most have mild disease course. • Data on children on dialysis are scarce. What is New: • Pediatric patients undergoing dialysis and kidney transplantation have an increased risk for COVID-19. • Most patients undergoing renal replacement therapy either on dialysis or transplanted develop asymptomatic or mild COVID-19 disease with a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation

et al. 2021

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“…According to a multicenter European Study, the reported mortality rate of COVID-19 is 0.7% among the general pediatric population [25]. This rate ranges from 0 to 3.5% in children with coexisting kidney disease [7,8,12,21]. In our cohort of 49 children with RRT, one child on HD died from COVID-19.…”

Section: Discussionmentioning

confidence: 66%

“…The mortality rate of COVID-19 rises to 32% in adult patients with ESKD on maintenance dialysis [4][5][6]. However, the limited available data suggest that COVID-19 is uncommon in children with advanced stages of CKD and the disease has a mild course in children on chronic dialysis [7,8].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in Children with Chronic Dialysis and Kidney Transplantation

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et al. 2021

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The aim of the study is to present incidence of COVID-19 in children with renal replacement therapy (RRT) and compare the severity and outcomes of the disease between the groups undergoing dialysis and kidney transplantation (KTx). This multicenter observational study was based on data collected from children receiving RRT, either chronic dialysis or KTx, diagnosed with COVID-19. All members of the Istanbul branch of the Turkish Pediatric Nephrology Association were requested to submit all their confirmed COVID-19 cases between April 1 and December 31, 2020. They were also asked to report the number of their prevalent patients on RRT under the age of 20. A total of 46 RRT patients diagnosed with COVID-19 were reported from 12 centers. Of these, 29 were KTx recipients, and 17 were on dialysis. COVID-19 cases represented 9.3% of all prevalent dialysis patients and 9.2% of all prevalent KTx recipients. Twelve KTx recipients (41.4%) and three dialysis patients (17.6%) were asymptomatic (p = 0.12). The hospitalization rate was higher in dialysis patients than KTx recipients (82.4% vs. 27.6%, p = 0.001). Two patients, one in each group, experienced a severe disease course, and only one hemodialysis patient had a critical illness that required mechanical ventilation. Acute kidney injury developed in 36% of KTx recipients, but none required dialysis or lost their graft. In the entire cohort, one patient on hemodialysis with multiple comorbidities died.Conclusion: Although most of cases were asymptomatic or had a mild disease, children on RRT seem to have an increased risk for COVID-19.

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“…Limited data for paediatric oncology, liver transplant, chronic kidney disease and inflammatory bowel disease patients are reassuring, with few cases of mostly mild infection reported. [12][13][14][15][16] While some studies show adult patients on immunosuppressive biologicals may not be at higher risk of severe disease, 17 other analyses suggest that adults with malignancy, autoimmune conditions, asplenia and other immunosuppressive conditions are at greater risk of COVID-19 related death. 18 However, the contribution of immunosuppression to SARS-CoV-2 disease severity in children remains unclear due to the low prevalence of severe disease in this age group.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 symptom surveillance in immunocompromised children and young people in the UK: a prospective observational cohort study

et al. 2021

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ObjectivesTo describe the frequency of symptoms compatible with SARS-CoV-2 infection in immunocompromised children and young people in the UK during the SARS-CoV-2 pandemic. To describe patient/parent anxiety regarding SARS-CoV-2 infection in this cohort.DesignA prospective observational cohort study.Setting46 centres across the UK between 16 March and 4 July 2020. A weekly online questionnaire based on the International Severe Acute Respiratory and emerging Infections Consortium-WHO Case Report Form was used to collect participant reported data on symptoms, test results, National Health Service attendance, hospital admission and impact on daily life.Participants1490 immunocompromised children, defined as those requiring an annual influenza vaccination due to their underlying condition or medication.Main outcome measuresIncidence of SARS-CoV-2-like symptoms and patient/parent anxiety score.ResultsOver 16 weeks during the first wave of the pandemic, no SARS-CoV-2 infection was diagnosed in this large immunocompromised paediatric cohort (median age 11 years, 54.4% female). 110 symptomatic participants underwent a test for SARS-CoV-2; all were negative. 922 (67.4%) participants reported at least one symptom consistent with suspected SARS-CoV-2 infection over the study period. 476 (34.8%) reported three or more symptoms. The most frequently reported symptoms included joint pain, fatigue, headache, nausea and muscle pain. SARS-CoV-2 testing during this period was performed on admitted patients only. 137 participants had their medication suspended or changed during the study period due to assumed COVID-19 disease risk. 62% reported high levels of anxiety (scores of 7–10 out of 10) at the start of the study, with anxiety levels remaining high throughout the study period.ConclusionsAlthough symptoms related to SARS-CoV-2 infection in children were common, there were no positive tests in this large immunocompromised cohort. Symptom-based screening to facilitate early detection of SARS-CoV-2 infection may not be helpful in these individuals. Patient/parent anxiety about SARS-CoV-2 infection was high.Trial registration numberNCT04382508.

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COVID-19 in children with chronic kidney disease: findings from the UK renal registry

Cited by 19 publications

References 4 publications

COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation

COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation

COVID-19 in Children with Chronic Dialysis and Kidney Transplantation

COVID-19 symptom surveillance in immunocompromised children and young people in the UK: a prospective observational cohort study

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