Li Lu, Zhou Ting, Lu Yiwen, Chen Jiajie, Lei Yuqing, Wu Qiong, Arnold Jonathan, Becich Michael J, Bisyuk Yuriy, Blecker Saul, Chrischilles Elizabeth, Christakis Dimitri A, Geary Carol Reynolds, Jhaveri Ravi, Lenert Leslie, Liu Mei, Mirhaji Parsa, Morizono Hiroki, Mosa Abu S M, Onder Ali Mirza, Patel Ruby, Smoyer William E, Taylor Bradley W, Williams David A, Dixon Bradley P, Flynn Joseph T, Gluck Caroline, Harshman Lyndsay A, Mitsnefes Mark M, Modi Zubin J, Pan Cynthia G, Patel Hiren P, Verghese Priya S, Forrest Christopher B, Denburg Michelle R, Chen Yong
The Center for Health AI and Synthesis of Evidence, University of Pennsylvania, Philadelphia.
The Graduate Group in Applied Mathematics and Computational Science, School of Arts and Sciences, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2025 Apr 1;8(4):e254129. doi: 10.1001/jamanetworkopen.2025.4129.
It remains unclear whether children and adolescents with SARS-CoV-2 infection are at heightened risk for long-term kidney complications.
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).
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.
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.
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.
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.
目前尚不清楚感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的儿童和青少年是否有更高的长期肾脏并发症风险。
调查SARS-CoV-2感染是否与儿科患者急性肾损伤后不良肾脏结局风险增加相关，包括那些已有肾脏疾病或急性肾损伤（AKI）的患者。
设计、设置和参与者：这项回顾性队列研究使用了美国国立卫生研究院“研究COVID以促进康复（RECOVER）”倡议中19个医疗机构的数据，时间从2020年3月1日至2023年5月1日（随访截至2024年12月1日完成，随访时间≤2年；索引日期截止于2022年12月1日）。参与者包括儿童和青少年（年龄<21岁），他们至少有1次基线就诊（索引日期前24个月至7天）和至少1次随访就诊（索引日期后28至179天）。
SARS-CoV-2感染，通过实验室检测结果阳性（聚合酶链反应、抗原或血清学检测）或相关临床诊断确定。一个对照组包括检测结果记录为阴性且无SARS-CoV-2感染史的儿童。
结局包括新发慢性肾脏病（CKD）2期或更高分期，或在无既往CKD的患者中出现CKD 3期或更高分期；复合肾脏事件（估计肾小球滤过率[eGFR]下降≥50%、eGFR≤15 mL/min/1.73 m²、透析、移植或终末期肾病诊断），以及在已有CKD或急性期AKI的患者中eGFR至少下降30%、40%或50%。使用倾向评分分层的Cox比例风险回归模型估计风险比（HR）。
在1900146名儿科患者中（487378名感染新冠病毒，1412768名未感染），969937名（51.0%）为男性，平均（标准差）年龄为8.2（6.2）岁，存在一系列合并症。SARS-CoV-2感染与新发CKD 2期或更高分期（HR，1.17；95%置信区间，1.12 - 1.22）和CKD 3期或更高分期（HR，1.35；95%置信区间，1.13 - 1.62）的更高风险相关。在已有CKD的患者中，新冠病毒感染与28至179天时复合肾脏事件风险增加相关（HR，1.15；95%置信区间，1.04 - 1.27）。急性期AKI患儿在90至179天时复合结局的HR升高（1.29；95%置信区间，1.21 - 1.38）。
在这项针对美国儿童和青少年的大型队列研究中，SARS-CoV-2感染与急性肾损伤后不良肾脏结局的更高风险相关，尤其是在已有CKD或AKI的患者中，这表明需要进行长期的密切监测。
