COVID-19 disease in Pakistani children with chronic kidney disease on hemodialysis – a tertiary care experience

OBJECTIVE: COVID-19 is a novel viral disease caused by SARS-CoV-2 which has rapidly spread throughout the world. We determined the clinical course and outcome of COVID-19 disease in Pakistani children with chronic kidney disease (CKD) on maintenance hemodialysis during the first wave of the pandemic. PATIENTS AND METHODS: The study was conducted in the hemodialysis unit at the University of Child Health Sciences and Children’s Hospital, Lahore, Pakistan. Patients of both sexes below 18 years of age on maintenance hemodialysis with COVID-19 disease confirmed by PCR were included. Data were collected regarding underlying etiology of CKD as well as symptomatology, treatment received and outcome of COVID-19 disease. RESULTS: 9 patients were confirmed as COVID-19 positive by PCR – 56% were males with a median age of 11 years. The most common underlying etiology of chronic kidney disease was obstructive uropathy (22.2%) with fever and cough reported to be the most common presenting symptoms. Only 6% of the children had neutropenia while all others had normal white cell count. Radiological findings revealed diffuse inflammatory infiltration of lungs in all the participants with ground-glass haze in 11% of the subjects. The patients were managed with supportive treatment, antimicrobial coverage, and systemic steroids along with oxygen supplementation while mechanical ventilation with inotropic support was required in almost a quarter and bi-level positive airway pressure in 11% of the children. CONCLUSIONS: Our study showed that even children in the advanced stages of CKD were at low risk of developing COVID-19 disease. More than 50% of the patients were discharged uneventfully while 20% of the subjects expired due to severe COVID disease.