Systematic review and meta-analysis of cardiovascular event incidence and risk factors in pediatric dialysis patients.

BACKGROUND

Cardiovascular disease (CVD) and left ventricular hypertrophy (LVH) are prevalent complications in pediatric and adolescent dialysis patients, elevating morbidity and mortality risks. Despite existing studies on cardiovascular risks, a systematic synthesis of their prevalence and contributing factors is lacking. This study aims to establish an evidence-based foundation to guide clinical interventions.

METHODS

We systematically searched PubMed, Embase, Cochrane Library, and Web of Science until March 2025. Cardiovascular events and determinants were descriptively analyzed, while LVH prevalence underwent meta-analysis using a random-effects model. Heterogeneity sources were explored via sensitivity and subgroup analyses (stratified by dialysis modality and study quality), with intergroup differences assessed by mixed-effects meta-regression. Study quality was evaluated using the Newcastle-Ottawa scale (NOS) for observational studies and the Agency for Healthcare Research and Quality checklist for cross-sectional studies. Heterogeneity was quantified with Cochran Q and I2 statistics.

RESULTS

Ten observational studies (5 cohorts, 5 cross-sectional) enrolling 6012 pediatric and adolescent dialysis patients (publication years 1996-2023) were included in the final analysis. The random-effects meta-analysis revealed a pooled LVH prevalence of 56% (95% confidence intervals (CI): 44-69%; I2 = 81.9%, P < .001), indicating substantial heterogeneity. Subgroup analyses demonstrated a numerically higher LVH prevalence in hemodialysis (HD) (66.0%, 95% CI: 52-78%) versus peritoneal dialysis (PD) patients (51.5%, 95% CI: 38-65%), though this difference lacked statistical significance (P = .204). Age, gender, and HD modality were independent risk factors. The incidence of cardiovascular-related events was significantly higher in female patients than in males.

CONCLUSION

Pediatric dialysis patients show significantly higher risks of cardiovascular events and LVH versus controls. This necessitates regular primary echocardiographic monitoring, blood pressure optimization, and risk stratification. Future multicenter studies should: provide optimal dialysis modalities; conduct high-quality research to inform clinical interventions.