Outcomes and risk factors for death among hospitalized children and adolescents with kidney diseases and COVID-19: an analysis of a nationwide database

Abstract

Background Patients with kidney diseases (KD) appear to be at particularly high risk for severe COVID-19. This study aimed to characterize the clinical outcomes and risk factors for COVID-19-related death in a large cohort of hospitalized pediatric patients with KD. Methods We performed an analysis of all pediatric patients with KD and COVID-19 registered in SIVEP-Gripe, a Brazilian nationwide surveillance database, between February 16, 2020, and May 29, 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using cumulative incidence function. Results Among 21,591 hospitalized patients with COVID-19, 290 cases (1.3%) had KD. Of these, 59 (20.8%) had a fatal outcome compared with 7.5% of the non-KD cohort ( P < 0.001). Pediatric patients with KD had an increased hazard of death compared with the non-KD cohort (Hazard ratio [HR] = 2.85, 95% CI 2.21–3.68, P < 0.0001). After adjustment, the factors associated with the death among KD patients were living in Northeast (HR 2.16, 95% CI 1.13–4.31) or North regions (HR 3.50, 95% CI 1.57–7.80), oxygen saturation < 95% at presentation (HR 2.31, 95% CI 1.30–4.10), and presence of two or more associated comorbidities (HR 2.10, 95% CI 1.08–4.04). Conclusions Children and adolescents with KD had a higher risk of death compared with the non-KD cohort. The higher risk was associated with low oxygen saturation at admission, living in socioeconomically disadvantaged regions, and presence of other pre-existing comorbidities. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information Supplementary Information The online version contains a graphical abstract available at 10.1007/s00467-022-05588-0.

The association between pre‐existing asthma and reduced risk of death among children and adolescents hospitalized with COVID‐19 in Brazil

“…As observed in adult cohorts, the coexistence of comorbidities, including diabetes, obesity, kidney disease, and hematology/oncology, has been clearly associated with severe illness and mortality in pediatric patients with COVID-19. 3,[23][24][25][26] However, our results also showed a history of asthma without another associated underlying medical condition as a strong protective factor against fatal outcomes in children and adolescents hospitalized with SARS-CoV-2 infection during the first 2 years of the pandemic in Brazil. Notably, compared with healthy children, this group had an approximately 60% reduction in risk of death (HR = 0.39, 95% CI, 0.29-0.56).…”

“…We found that the presence of comorbidities and the presence of asthma associated with chronic medical conditions tripled and doubled the risk of death compared to healthy children. As observed in adult cohorts, the coexistence of comorbidities, including diabetes, obesity, kidney disease, and hematology/oncology, has been clearly associated with severe illness and mortality in pediatric patients with COVID‐19 3,23–26 …”

Use of Sotrovimab in 14 Children with COVID-19: A Single-center Experience

“…Although most data point to a low risk of severe disease in this patient cohort, 1 recent article from Brazil showed a significantly higher mortality rate among children with kidney disease as compared with children without kidney disease. 7 The tolerability of mAb infusion was excellent in our cohort. While in a previously published trial on adults, diarrhea was the most common reported adverse event (2%) and systemic infusionrelated reactions (including hypersensitivity reactions) were seen in 1% in the sotrovimab-treated group as well as in the placebo group, 8 no incidents were reported in our cohort and no infusionrelated reactions occurred.…”

“…Although most data point to a low risk of severe disease in this patient cohort, 1 recent article from Brazil showed a significantly higher mortality rate among children with kidney disease as compared with children without kidney disease. 7…”

Clinical Outcomes of Omicron Variant (B.1.1.529) Infection in Children and Adolescents Hospitalized With COVID-19 in Brazil With Observational Data on the Efficacy of the Vaccines in Adolescents

“…The various strategies to partially overcome these limitations are described in detail in our previous studies. 5,6,22,23,27 In conclusion, among hospitalized children and adolescents with COVID-19, the omicron variant was associated with a lower death rate than the previous variants but still resulted in substantial morbidity and mortality. In this Brazilian cohort, the fatal outcome was associated with young age (<2 years), hospitalization in the poorest regions, pre-existing medical conditions, and early signs of pulmonary involvement.…”