Background Children are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.
Methods Cross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.
Results 113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.
Conclusions This global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.
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Twitter @al_samhar, @NeckerNephroPed, @GovindDrsuk
Contributors KT, FS, MM and TW devised the idea for the study, KT, FS, MM, TW, LP, BT and MV planned the study set-up and coordinated the study data collection. All authors contributed to study data collection and reviewing of the manuscript to be published. All authors have reviewed the manuscript and all those named in the acknowledgements have given written consent to do so. MM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This survey has been supported by European Rare Kidney Disease Reference Network (ERKNet). ERKNet is co-funded by the European Union within the framework of the Third Health Programme 'ERN-2016 Framework Partnership Agreement 2017–2021'.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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