COVID-19 impact poses low risk to children with advanced CKD, immunosuppression
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Data from Italy indicate the impact of COVID-19 is not greater for children with chronic kidney disease or immunosuppression compared with a pediatric cohort who have neither condition.
“Italy was one of the countries most affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak,” Antonio Mastrangelo, MD, of the pediatric nephrology, dialysis and transplant unit at Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Ca` Granda, Ospedale Maggiore Policlinico in Milan, and colleagues, wrote in a research letter. “Although adults with CKD and kidney transplant recipients are known to be at greater risk for disease severity due to immunosuppression and comorbidities, little is known about the equivalent pediatric population.”
The researchers wrote that because children who have CKD or who are receiving kidney replacement therapy are at increased risk for infection due to immunosuppression and contact in dialysis units and hospital visits, it is important to understand how they might be impacted by the virus.
With this aim, Mastrangelo and colleagues examined data from a nationwide observational study conducted during the country’s lockdown period. They focused on patients who were younger than the age of 18 years and who had either primary or secondary glomerulonephritis and idiopathic nephrotic syndrome requiring long-term immunosuppressive therapy, CKD stages 3 to 5, dialysis or kidney transplant (n = 1,572; median age, 11.1 years).
“The primary objective was to identify patients with severe COVID-19 as defined by any of the following: death, admission to Pediatric Intensive Care Unit, mechanical ventilation, and the need to change ongoing immunosuppressive treatment due to a documented SARS-CoV-2 infection,” they wrote.
Results showed COVID-19 posed little risk to this patient population.
“No patient in our fragile population had severe COVID-19,” the researchers elaborated. “The absolute risk of SARS-CoV-2 infection was not significant, and the ratio of positive to performed tests is comparable with the general pediatric population.”
According to Mastrangelo and colleagues, the reason behind why the general pediatric population has a low incidence of the virus remains unclear.
These findings demonstrate that even children who would appear to be at high-risk (based on adult cohorts with similar characteristics), also have a low risk of “clinically relevant COVID-19.”
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