Kidney function following COVID-19 in children and adolescents

Li, L; Zhou, T; Lu, Y; et al., JAMA Network Open, April 2025

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April 2025
JAMA Network Open

Short Summary

This RECOVER study looked at whether children to young adults ages 21 and younger who had COVID-19 were more likely to have long-term kidney problems. Researchers reviewed the electronic health records (EHRs) of over 1.9 million children and young adults up to 20 years old. About 487,000 of them had COVID-19. They found that children and young adults who had COVID-19 were about 17% more likely to get a new kidney disease and about 35% more likely to get a more serious type of kidney disease. The risk of having worsening problems was high for children and young adults who already had kidney disease (about 15% more likely), or who had a kidney injury (about 29% more likely) when they were first sick with COVID-19. These findings are important because they suggest that doctors should closely monitor the kidney health of young patients after having COVID-19.

This summary was prepared by the RECOVER Initiative.

Publication Details

DOI: 10.1001/jamanetworkopen.2025.4129

Abstract

Importance: It remains unclear whether children and adolescents with SARS-CoV-2 infection are at heightened risk for long-term kidney complications.

Objective: To investigate whether SARS-CoV-2 infection is associated with an increased risk of postacute kidney outcomes among pediatric patients, including those with preexisting kidney disease or acute kidney injury (AKI).

Design, setting, and participants: This retrospective cohort study used data from 19 health institutions in the National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) initiative from March 1, 2020, to May 1, 2023 (follow-up ≤2 years completed December 1, 2024; index date cutoff, December 1, 2022). Participants included children and adolescents (aged <21 years) with at least 1 baseline visit (24 months to 7 days before the index date) and at least 1 follow-up visit (28 to 179 days after the index date).

Exposures: SARS-CoV-2 infection, determined by positive laboratory test results (polymerase chain reaction, antigen, or serologic) or relevant clinical diagnoses. A comparison group included children with documented negative test results and no history of SARS-CoV-2 infection.

Main outcomes and measures: Outcomes included new-onset chronic kidney disease (CKD) stage 2 or higher or CKD stage 3 or higher among those without preexisting CKD; composite kidney events (≥50% decline in estimated glomerular filtration rate [eGFR], eGFR ≤15 mL/min/1.73 m2, 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. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models with propensity score stratification.

Results: Among 1 900 146 pediatric patients (487 378 with and 1 412 768 without COVID-19), 969 937 (51.0%) were male, the mean (SD) age was 8.2 (6.2) years, and a range of comorbidities was represented. SARS-CoV-2 infection was associated with 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). In those with preexisting CKD, 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. Children with acute-phase AKI had elevated HRs (1.29; 95% CI, 1.21-1.38) at 90 to 179 days for composite outcomes.

Conclusions and relevance: In this large US cohort study of children and adolescents, SARS-CoV-2 infection was associated with a higher risk of adverse postacute kidney outcomes, particularly among those with preexisting CKD or AKI, suggesting the need for vigilant long-term monitoring.

Authors

Lu Li, Ting Zhou, Yiwen Lu, Jiajie Chen, Yuqing Lei, Qiong Wu, Jonathan Arnold, Michael J Becich, Yuriy Bisyuk, Saul Blecker, Elizabeth Chrischilles, Dimitri A Christakis, Carol Reynolds Geary, Ravi Jhaveri, Leslie Lenert, Mei Liu, Parsa Mirhaji, Hiroki Morizono, Abu S M Mosa, Ali Mirza Onder, Ruby Patel, William E Smoyer, Bradley W Taylor, David A Williams, Bradley P Dixon, Joseph T Flynn, Caroline Gluck, Lyndsay A Harshman, Mark M Mitsnefes, Zubin J Modi, Cynthia G Pan, Hiren P Patel, Priya S Verghese, Christopher B Forrest, Michelle R Denburg, Yong Chen, RECOVER Consortium

Keywords

Humans; COVID-19/complications/epidemiology/physiopathology; Adolescent; Child; Male; Female; Retrospective Studies; Acute Kidney Injury/epidemiology/physiopathology/etiology; Child, Preschool; SARS-CoV-2; Glomerular Filtration Rate; Renal Insufficiency, Chronic/epidemiology; Risk Factors; Infant; United States/epidemiology