Critical analysis of acute kidney injury in pediatric COVID-19 patients in the intensive care unit

Rupesh Raina, Ronith Chakraborty, Isabelle Mawby, Nirav Agarwal, Sidharth Sethi, Michael Forbes, Rupesh Raina, Ronith Chakraborty, Isabelle Mawby, Nirav Agarwal, Sidharth Sethi, Michael Forbes

Abstract

Background and objectives: COVID-19 is responsible for the 2019 novel coronavirus disease pandemic. Despite the vast research about the adult population, there has been little data collected on acute kidney injury (AKI) epidemiology, associated risk factors, treatments, and mortality in pediatric COVID-19 patients admitted to the ICU. AKI is a severe complication of COVID-19 among children and adolescents.

Methods: A comprehensive literature search was conducted in PubMed/MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID-19 patients, including incidence and outcomes.

Results: Twenty-four studies reporting the outcomes of interest were included. Across all studies, the overall sample size of COVID positive children was 1,247 and the median age of this population was 9.1 years old. Among COVID positive pediatric patients, there was an AKI incidence of 30.51%, with only 0.56% of these patients receiving KRT. The mortality was 2.55% among all COVID positive pediatric patients. The incidence of multisystem inflammatory syndrome in children (MIS-C) among COVID positive patients was 74.29%.

Conclusion: AKI has shown to be a negative prognostic factor in adult patients with COVID-19 and now also in the pediatric cohort with high incidence and mortality rates. Additionally, our findings show a strong comparison in epidemiology between adult and pediatric COVID-19 patients; however, they need to be confirmed with additional data and studies.

Keywords: Acute kidney injury; Adult; COVID-19; Kidney replacement therapy; MIS-C; Pediatric.

Conflict of interest statement

The authors declare no competing interest.

© 2021. IPNA.

Figures

Fig. 1
Fig. 1
Prisma flowchart for pediatric studies
Fig. 2
Fig. 2
Forest plot of the meta-analysis of pediatric AKI incidence among COVID-positive patients across different studies. The lower diamond in the graph represents the pooled estimate
Fig. 3
Fig. 3
Funnel plot for pediatric AKI incidence among COVID-positive patients
Fig. 4
Fig. 4
Forest plot of the meta-analysis of pediatric mortality among COVID-positive patients across different studies. The lower diamond in the graph represents the pooled estimate
Fig. 5
Fig. 5
Funnel plot for pediatric mortality among COVID-positive patients
Fig. 6
Fig. 6
(a) Comparison of the adult vs. pediatric COVID-19 population. (b) World map of pediatric vs. adult COVID-19 studies. (c) COVID-19 clinical data from North American pediatric intensive care units (https://www.covid19.myvps.org)

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Source: PubMed

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