Study Shows Incidence of Acute Kidney Injury in Critically Ill Children Is Significantly Higher with COVID-19
Occurrence of acute kidney injury (AKI) in children critically ill with the coronavirus (COVID-19) was about double that of the normal occurrence of AKI in the critically ill pediatric population, according to a study of 41 centers worldwide. The study was coordinated by Cincinnati Children’s and recently reported in the Clinical Journal of the American Society of Nephrology.
During the early days of the pandemic, Cincinnati Children’s pediatric nephrologist Stuart Goldstein, MD, and four other physicians nationally noticed the high incidence of AKI and need for dialysis in critically ill adults with COVID-19. Concerned by the potential implications for the pediatric population, the physicians and a nurse researcher pulled together the international study in less than a week.
“In April 2020, we wondered if we needed to prepare for a large wave of children needing dialysis in the ICUs,” says Kelli Krallman MS, research nurse at the Cincinnati Children’s Center for Acute Care Nephrology, who coordinated the study. Krallman rapidly handled logistics of institutional review board approvals, building a database and other essential operational issues.
The study identified 106 children hospitalized in the United States and internationally for severe COVID-19 during April and May of 2020. It assessed the frequency of AKI and the need for dialysis among these patients. Of those children, nearly half developed AKI, with 47% at stage 1, 23% at stage 2 and 30% at stage 3. No child received dialysis. Six children died, all with chronic diseases compounding their illness.
Krallman adds, “Multi-system inflammatory syndrome affecting organ function, including kidneys, has been more prevalent in severe pediatric cases than respiratory issues. The most severe symptoms appear about a week to a month after onset of COVID-19.”
Study Implications for Clinicians
As SARS-CoV-2 continues to evolve and claim lives in large numbers, Krallman predicts that AKI rates in critically ill children are likely to rise.
She and her co-authors urge pediatric nephrologists and critical care physicians to be diligent with early AKI identification, attention to fluid balance and monitoring medications.
Krallman emphasizes, “It’s important to minimize nephrotoxic medications in any child with symptoms of COVID-19. Physicians can counsel parents on which meds to possibly avoid during acute illness and how to monitor fluid intake and output.”
She continues, “With AKI, we’re trying to avoid continuous renal replacement therapy at all costs, because the rate of mortality or not recovering kidney function is very high.”
To determine the long-term consequences of AKI, Cincinnati Children’s is conducting a prospective five-year follow-up study.
(Published February 2026)
