Masked hypertension and non-dipping blood pressure profiles in pediatric survivors of acute kidney injury: a systematic review and meta-analysis.

Pediatric acute kidney injury (AKI) is increasingly recognized as a condition with long-term chronic consequences, rather than a transient, self-limiting event, carrying an elevated risk of both cardiovascular and renal sequelae. Conventional clinic-based blood pressure measurements may fail to detect subclinical hemodynamic abnormalities, potentially underestimating this burden. This systematic review and meta-analysis aimed to evaluate the pooled prevalence of masked hypertension and abnormal nocturnal blood pressure dipping patterns-assessed specifically by 24-hour ambulatory blood pressure monitoring (ABPM)-in pediatric AKI survivors. A systematic search of PubMed/MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science was conducted from database inception to March 2, 2026, without language restrictions. We targeted observational studies tracking children or adolescents with a prior history of AKI who underwent long-term ABPM follow-up. Screening, data extraction, and quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklist were performed independently by two reviewers. Data were synthesized from six studies capturing a total of 150 pediatric AKI survivors. The pooled prevalence of masked hypertension across five cohorts was 12% (95% CI: 4%-23%), and the pooled prevalence of a non-dipping blood pressure profile across five cohorts was 37% (95% CI: 26%-49%). Sensitivity analyses demonstrated the stability of these estimates. The high prevalence of subclinical blood pressure abnormalities suggests that office-based measurements alone may be insufficient for risk detection. Incorporating ABPM into the post-AKI follow-up of selected pediatric populations may enhance cardiovascular risk stratification and warrants consideration in future clinical guidelines.