Acute Kidney Injury and SARS-CoV-19 in Children: Data from the National COVID Cohort Collaborative
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Worldwide Data, Crisis Management, Pediatrics, 2022
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INTRODUCTION: Acute Kidney Injury (AKI) occurs frequently in adult patients with SARS-CoV-19 and confers a higher risk of mortality. Harmonized, multi-institution datasets such as the National COVID Cohort Collaborative (N3C), a repository of over 6.3 million patients from 56 sites, offer a unique opportunity to assess AKI and clinical outcomes. We sought to determine the association of SARS-CoV-19 infection and AKI among children within N3C.
METHODS: We conducted a retrospective cohort study on children ≤18 years old with SARS-CoV-2 positive PCR or antigen test. We stratified disease severity using the World Health Organization (WHO) Clinical Progression Scale. We defined AKI by KDIGO creatinine criteria and examined exposure to nephrotoxic medications. Outcomes included case incidence, mortality and length of stay. Univariate analyses compared AKI versus no AKI across severity groups.
RESULTS: As of 6/23/2021, a total of 90,169 children tested positive for SARS-CoV-2 in N3C. Among 5,193 (5.7%) hospitalized children, 3,060 (59%) met criteria for AKI. Only 69 children died, of whom 55 (80%) met AKI criteria. AKI was associated with disease severity (χ2, p < 0.001), with 457/602 (76%) of severe patients, but only 9,817/75,209 (13%) of mild patients, meeting AKI criteria. AKI was common among patients requiring vasoactive medication (375/474, 79%), mechanical ventilation (242/318, 76%) and ECMO (27/29, 93%). Length of stay was significantly longer among hospitalized children with AKI (mean [SD] 2.9 [7.3] days vs 0.5 [18] days). Only 1,026 (20%) of hospitalized children were administered nephrotoxic medications. Of these, 877 (85.5%) met criteria for AKI. The most common nephrotoxic medications given were vancomycin, ibuprofen, and ketorolac.
CONCLUSIONS: In a large multi-institutional sample of children infected with SARS-CoV-2, we demonstrate increased frequency of AKI with greater disease severity. Additionally, AKI was common (~85%) among inpatients exposed to nephrotoxic medications. Collaborative datasets such as N3C, along with associated shared data analytics tools, provide valuable resources for observational research in pediatric critical care and AKI.
Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Crisis Management
Knowledge Area Worldwide Data
Knowledge Level Foundational
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Epidemiology Outcomes
Tag Pediatrics
Tag COVID-19
Year 2022
acute kidney injury
SARS-CoV-2 infection


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