Post-acute and Chronic Kidney Function Outcomes of COVID-19 in Children and Adolescents: An EHR Cohort Study from the RECOVER Initiative

We investigated the risks of post-acute and chronic adverse kidney outcomes of SARS-CoV-2 infection in the pediatric population via a retrospective cohort study using data from the RECOVER program. We included 1,864,637 children and adolescents under 21 from 19 childrens hospitals and health institutions in the US with at least six months of follow-up time between March 2020 and May 2023. We divided the patients into three strata: patients with pre-existing chronic kidney disease (CKD), patients with acute kidney injury (AKI) during the acute phase (within 28 days) of SARS-CoV-2 infection, and patients without pre-existing CKD or AKI. We defined a set of adverse kidney outcomes for each stratum and examined the outcomes within the post-acute and chronic phases after SARS-CoV-2 infection. In each stratum, compared with the non-infected group, patients with COVID-19 had a higher risk of adverse kidney outcomes. For patients without pre-existing CKD, there were increased risks of CKD stage 2+ (HR 1.20; 95% CI: 1.13-1.28) and CKD stage 3+ (HR 1.35; 95% CI: 1.15-1.59) during the post-acute phase (28 days to 365 days) after SARS-CoV-2 infection. Within the post-acute phase of SARS-CoV-2 infection, children and adolescents with pre-existing CKD and those who experienced AKI were at increased risk of progression to a composite outcome defined by at least 50% decline in estimated glomerular filtration rate (eGFR), eGFR <15 mL/min/1.73m2, End Stage Kidney Disease diagnosis, dialysis, or transplant. Lay abstractThis study examined the impact of COVID-19 on kidney health in children and adolescents under 21 years old in the United States. Using data from the RECOVER program, we analyzed the health records of 1,864,637 young individuals from 19 hospitals and health institutions between March 2020 and May 2023. The study focused on three groups: those with pre-existing chronic kidney disease (CKD), those who experienced acute kidney injury (AKI) during the initial COVID-19 infection, and those without any prior kidney issues. The results showed that children and adolescents who had COVID-19 were at a higher risk of developing serious kidney problems later on, even if they had no previous kidney conditions. This research highlights the long-term effects of COVID-19 on kidney health in young people and underscores the importance of monitoring kidney function in pediatric COVID-19 patients.