BACKGROUND: COVID-19 was declared a global health emergency. Since children are less than 1% of reported cases, there is limited information to develop evidence-based practice recommendations. The objective of this study was to rapidly gather expert knowledge and experience to guide the care of children with chronic kidney disease during the COVID-19 pandemic. METHODS: A four-round multi-center Delphi exercise was conducted among 13 centers in 11 European countries of the European Pediatric Dialysis Working Group (EPDWG) between March, 16th and 20th 2020. Results were analyzed using a mixed methods qualitative approach and descriptive statistics. RESULTS: Thirteen COVID-19 specific topics of particular need for guidance were identified. Main themes encompassed testing strategies and results (n = 4), changes in use of current therapeutics (n = 3), preventive measurements of transmission and management of COVID-19 (n = 3), and changes in standard clinical care (n = 3). Patterns of center-specific responses varied according to regulations and to availability of guidelines. CONCLUSIONS: As limited quantitative evidence is available in real time during the rapid spread of the COVID-19 pandemic, qualitative expert knowledge and experience represent the best evidence available. This Delphi exercise demonstrates that use of mixed methodologies embedded in an established network of experts allowed prompt analysis of pediatric nephrologists' response to COVID-19 during this fast-emerging public health crisis. Such rapid sharing of knowledge and local practices is essential to timely and optimal guidance for medical management of specific patient groups in multi-country health care systems such as those of Europe and the US.

Department of Pediatric Nephrology Hôpital Femme Mère Enfant Hospices Civils de Lyon Lyon France

Department of Pediatric Nephrology KfH Children's Kidney Center Marburg Germany

Department of Pediatric Nephrology Medical University of Gdansk Gdansk Poland

Department of Pediatric Nephrology Mitera Children's Hospital Athens Greece

Department of Pediatric Nephrology University Hospital Motol Prague Czech Republic

Department of Pediatric Nephrology University Hospital Vall d' Hebron Barcelona Spain

Department of Pediatric Nephrology Utoped Universitair Ziekenhuis Gent Ghent Belgium

Dialysis Unit Department of Pediatrics IRCCS Giannina Gaslini Genoa Italy

Division of Pediatric Nephrology and Gastroenterology Comprehensive Center for Pediatrics Medical University of Vienna Waehringer Guertel 18 20 1090 Vienna Austria

Pediatric Center Institute of Clinical Medicine Vilnius University Vilnius Lithuania

Pediatric Nephrology Center for Child and Adolescent Medicine Heidelberg Germany

Pediatric Nephrology Dialysis and Transplant Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Renal Unit UCL Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health London UK

Section for Outcomes Research Center for Medical Statistics Informatics and Intelligent Systems Medical University of Vienna Vienna Austria

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Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base - a European multicentre mixed methods study