{"doi":"10.2215/cjn.11470720","title":"Preliminary Assessment of Acute Kidney Injury in Critically Ill Children Associated with SARS-CoV-2 Infection","abstract":"The virus, severe acute respiratory syndrome coronavirus 2, that causes coronavirus disease 2019 (COVID-19) infected >12 million people around the world as of July 2020 (Johns Hopkins Coronavirus Tracker). Knowledge on pathophysiology, management, multiorgan effects, and postinfection complications is evolving. Several studies revealed variable AKI prevalence among hospitalized adults with COVID-19, as high as 76% in critically ill adults with higher risk of mortality (1). To our knowledge, no specific epidemiologic data on AKI in critically ill children with COVID-19 have been published, leading to gaps in our ability to plan for its implications in this ongoing pandemic. We are conducting a multicenter, point-prevalence AKI study among critically ill children with COVID-19. We provide an epidemiologic snapshot of AKI among this cohort. This cross-sectional analysis captured weekly data points. This interim analysis includes children (1 month to 18 years) from 41 centers (six countries; 32 in the United States) with confirmed severe acute respiratory syndrome coronavirus 2–positive diagnosis (on the basis of center testing protocols) admitted to intensive care units (ICUs) between April 15 and May 20, 2020. The primary outcome was AKI defined by Kidney Disease Improving Global Outcomes creatinine criteria. Admission and peak creatinine on data capture days (or previous day if unavailable) were used. Baseline creatinine was the lowest within 3 months before admission or, if unknown, estimated using previously validated methods (2). Hospital outcomes censored at 14 days were (1) deceased, (2) hospitalized in ICU ≥14 days, or (3) presumed ICU hospitalization <14 days (when a patient is not included in two weekly date capture time points or not included in three date capture points and length of stay dates are <14 days). Final 28-day hospital mortality was determined. Characteristics of participants with AKI versus participants without AKI were compared using distribution-appropriate univariable analyses. For characteristics with P value ≤0.10, univariable relative risks (RRs; 95% confidence intervals [95% CIs]) of AKI were calculated. All centers’ ethical review boards approved the study and waived consent requirement. Deidentified data were electronically entered into REDCap, and analysis was conducted in SAS, version 9.4. Only 26 of 41 (63%) centers (23 in the United States, three in Europe/Russia) had critically ill children who were COVID-19 positive during our catchment days. Of 106 included children, almost half (n=47; 44%; 95% CI, 35% to 54%) developed AKI: 47% (n=22) had stage 1, 23% (n=11) had stage 2, and 30% (n=14) had stage 3. No child received dialysis. Even though 71 children lacked baseline creatinine, AKI estimates were similar between those with and without a baseline creatinine (46%; 95% CI, 29% to 62% and 44%; 95% CI, 32% to 55%, respectively). Table 1 displays demographic and clinical characteristics of children with and without AKI. Most children had at least one comorbidity (n=71; 67%), and almost 6% died (n=6). Vasopressor support and admission diagnosis of shock/hemodynamic instability were the only factors associated with higher risk for AKI (RR, 1.6; 95% CI, 1.1 to 2.5 and RR, 2.3; 95% CI, 1.5 to 3.5, respectively). Table 1. - Epidemiology of AKI development among critically ill children who are coronavirus disease 2019 positive Characteristics Total Coronavirus Disease 2019 Positive AKI No AKI n (row %) 106 47 (44) 59 (56) Date of enrollment Week 1 25 (24) 10 (21) 15 (25) Week 2 16 (15) 9 (19) 7 (12) Week 3 9 (9) 4 (9) 5 (9) Week 4 15 (14) 6 (13) 9 (15) Week 5 21 (20) 12 (26) 9 (15) Week 6 20 (19) 6 (13) 14 (24) Age, yr, median (range) 11.0 (0.1–17.8) 10.5 (0.2–17.7) 11.0 (0.1–17.8) Age categories Infants, 0–1 yr 13 (12) 4 (9) 9 (15) Toddlers, 1–5 yr 17 (16) 9 (19) 8 (14) Children, 5–13 yr 30 (28) 15 (32) 15 (25) Adolescents, ≥13 yr 46 (43) 19 (40) 27 (46) Sex Females 52 (49) 26 (55) 26 (44) Males 54 (","journal":"Clinical Journal of the American Society of Nephrology","year":2020,"id":63635,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":43,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9643,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":336744,"name":"Kelli A. Krallman","orcid":"0000-0002-3275-2982","position":1,"is_corresponding":false},{"id":336745,"name":"David J. Askenazi","orcid":"0000-0002-6840-9887","position":2,"is_corresponding":false},{"id":251939,"name":"Michael Zappitelli","orcid":"0000-0002-9977-0536","position":3,"is_corresponding":false},{"id":108942,"name":"Stuart L. Goldstein","orcid":"0000-0003-3711-8785","position":4,"is_corresponding":false},{"id":336746,"name":"Rajit K. Basu","orcid":"0000-0002-3184-341X","position":5,"is_corresponding":false},{"id":338283,"name":"on behalf of the SPARC Investigators","orcid":null,"position":6,"is_corresponding":false},{"id":336743,"name":"Erica C. Bjornstad","orcid":"0000-0002-4191-9510","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-18T21:11:24.000992Z","pmid":"33144276","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}