When COVID-19 arrived, no guidance existed for looking after Canadian children with kidney disease during a pandemic. CAPN assembled a rapid response team, adapted the Canadian Society of Nephrology’s adult guidance for paediatric practice, and published it in the open-access Canadian Journal of Kidney Health and Disease so that every centre in the country could use it.
The CAPN COVID-19 Rapid Response Team was Mathieu Lemaire, Rahul Chanchlani, Cal Robinson, Michelle Ruhl, Amrit Kirpalani, Abdullah Alabbas, Damien Noone, Chia Wei Teoh, Valerie Langlois and Veronique Phan, with Mathieu Lemaire and Rahul Chanchlani as the steering committee. Dozens of colleagues across the country reviewed the drafts at CAPN webinars.
Canadian Society of Nephrology COVID-19 Rapid Response Program
Canadian nephrologists, led by the CSN/SCN, came together to summarise information and evidence for nephrologists on topics related to SARS-CoV-2 and coronavirus disease 2019. These papers are intended to inform clinical practice.
Guest editors
Catherine M. Clase, MB BChir, MSc, FRCPC, McMaster University, Hamilton
Rachel M. Holden, Queen’s University
Manish M. Sood, University of Ottawa
Published guidance
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Management of paediatric kidney transplant patients
Guidance from the Canadian Society of Transplantation Paediatric Group, developed with CAPN and reviewed at a CSN webinar, covering transplant listing, living donation, immunosuppression and follow-up through the pandemic.
Teoh CW, Gaudreault-Tremblay MM, Blydt-Hansen TD, Goldberg A, Arora S, Feber J, Langlois V, Ruhl M, Phan V, Morgan C, Acott P, Hamiwka L, on behalf of the CST Paediatric Group. Can J Kidney Health Dis 2020;7:2054358120967845.
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Management of children with glomerular diseases
Children with glomerular disease are more susceptible to infection, through reduced vaccine uptake, urinary loss of immunoglobulins and immunosuppressive treatment. These recommendations adapt the CSN’s adult glomerulonephritis guidance to paediatric practice.
Robinson C, Ruhl M, Kirpalani A, Alabbas A, Noone D, Teoh CW, Langlois V, Phan V, Lemaire M, Chanchlani R. Can J Kidney Health Dis 2020;7:2054358120970713.
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Guidelines for management of acute kidney injury in children
Adapted from the CSN adult AKI guidance for paediatric settings, covering fluid management, timing and modality of kidney replacement therapy, vascular access, anticoagulation, and how to proceed if CRRT machines, solutions or trained staff became scarce.
Alabbas A, Kirpalani A, Morgan C, Mammen C, Licht C, Phan V, Wade A, Harvey E, Zappitelli M, Clark EG, Hiremath S, Soroka SD, Wald R, Weir MA, Chanchlani R, Lemaire M. Can J Kidney Health Dis 2021;8:2054358121990135.
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Home and in-centre dialysis guidance
Fifteen areas of dialysis practice affected by the pandemic, from peritoneal dialysis catheter placement and home dialysis training through personal protective equipment, product delivery, identifying infected patients, resuscitation, and dialysis under fixed resources.
Alabbas A, Harvey E, Kirpalani A, Teoh CW, Mammen C, Pederson K, Nemec R, Davis TK, et al, Lemaire M, Chanchlani R. Can J Kidney Health Dis 2021;8:20543581211053458.
All four papers are open access under a Creative Commons licence, so they can be read, downloaded and shared without a subscription.
Other international guidelines related to COVID-19
Paediatric nephrology societies around the world produced guidance in the same period. These documents were written under acute uncertainty in 2020 and several of their recommendations have since been superseded, but together they record how the field responded.
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European Pediatric Dialysis Working Group
A four-round Delphi exercise across thirteen centres in eleven European countries, completed in five days in March 2020, identifying thirteen topics needing guidance: testing strategies, changes to therapeutics, preventing transmission, and changes to routine clinical care.
Eibensteiner F, Ritschl V, Ariceta G, et al, on behalf of the European Pediatric Dialysis Working Group. Rapid response in the COVID-19 pandemic: a Delphi study from the European Pediatric Dialysis Working Group. Pediatr Nephrol 2020;35:1669–1678.
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ERKNet, ESPN and IPNA: children on immunosuppression
A global cross-sectional study of 113 children from 30 countries taking immunosuppressive medication for kidney disease. Most had mild illness, and the authors concluded that these children should not be isolated more strictly than their peers, which mattered a great deal to families at the time.
Marlais M, Wlodkowski T, Al-Akash S, et al. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Arch Dis Child 2021;106:798–801. An earlier report appeared as: Marlais M, Wlodkowski T, Vivarelli M, Pape L, Tönshoff B, Schaefer F, Tullus K. Severity of COVID-19 in children on immunosuppressive medication. Lancet Child Adolesc Health 2020;4:e17–18.
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Chinese Society of Pediatric Nephrology
Consensus recommendations for children on chronic dialysis, published early in the pandemic and drawn on directly by CAPN’s own dialysis guidance.
Shen Q, Wang M, Che R, et al. Consensus recommendations for the care of children receiving chronic dialysis in association with the COVID-19 epidemic. Pediatr Nephrol 2020;35:1351–1357.
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Indian Society of Pediatric Nephrology
Practical guidance on managing children with kidney disease through the pandemic in a resource-constrained setting.
Vasudevan A, Mantan M, Krishnamurthy S, et al. Managing children with renal diseases during the COVID-19 pandemic. Indian Pediatr 2020;57:641–651.