Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Crit Care Explor. 2024 Jul 30;6(8):e1129. doi: 10.1097/CCE.0000000000001129. eCollection 2024 Aug 1.
Survivors of pediatric critical illnesses are at risk of significant long-term organ sequelae. Chronic kidney disease (CKD) is a complication of critical illness (and ICU interventions) associated with growth impairment, cardiovascular disease, and early death. Our objective was to synthesize the evidence on the incidence of CKD among survivors of pediatric critical illness.
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Register of Controlled Trials from inception to February 2024.
Observational studies reporting the incidence of de novo CKD among survivors of pediatric critical illness.
Two reviewers independently extracted data on study design, setting, population, demographics, diagnostic criteria, and outcome.
Meta-analysis was used to describe the incidence of CKD among survivors, risk of bias (RoB) assessed using the Joanna Briggs Institute Tool, and strength and reliability of evidence assessed with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). CKD was quantified as an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m2 (outcome 1), eGFR less than 60 mL/min/1.73 m2 (outcome 2), and end-stage renal disease (ESRD) as eGFR less than 15 mL/min per 1.73 m2 (outcome 3). Twelve studies (3642 patients) met selection criteria and reported at least one measure of CKD. The median duration of follow-up was 2, 3.6, and 5 years, respectively, for outcomes 1, 2, and 3. For each threshold, the pooled estimate of CKD incidence was 24% (95% CI, 16-32%) for eGFR less than 90, 14% (95% CI, 6-23%) less than 60, and 4% (95% CI, 0-7%) for ESRD. The overall quality assessment indicated a moderate RoB.
Among a heterogenous population of pediatric critical illness survivors, an important minority of survivors developed CKD or ESRD. This study highlights the importance of diagnostic criteria for reporting, a greater focus on postcritical care surveillance and follow-up to identify those with CKD. Further study would facilitate the delineation of high-risk groups and strategies for improved outcomes.
儿科危重病幸存者存在严重长期器官后遗症的风险。慢性肾脏病（CKD）是危重病（和 ICU 干预）的并发症，与生长障碍、心血管疾病和早逝有关。我们的目的是综合儿科危重病幸存者中 CKD 发病率的证据。
从开始到 2024 年 2 月，在 MEDLINE、Embase、累积索引到护理和联合健康文献以及 Cochrane 对照试验登记处进行了搜索。
报告儿科危重病幸存者中新发 CKD 发病率的观察性研究。
两名审查员独立提取了研究设计、环境、人群、人口统计学、诊断标准和结果的数据。
使用荟萃分析描述幸存者中 CKD 的发病率，使用 Joanna Briggs 研究所工具评估偏倚风险（RoB），并使用 GRADE（推荐评估、制定和评估分级）评估证据的强度和可靠性。CKD 被量化为估计肾小球滤过率（eGFR）小于 90 ml/min/1.73 m2（结果 1），eGFR 小于 60 ml/min/1.73 m2（结果 2）和终末期肾脏疾病（ESRD）作为 eGFR 小于 15 ml/min/1.73 m2（结果 3）。12 项研究（3642 名患者）符合选择标准，并报告了至少一项 CKD 测量值。结果 1、2 和 3 的中位随访时间分别为 2、3.6 和 5 年。对于每个阈值，CKD 发病率的汇总估计值分别为 eGFR 小于 90 的 24%（95%CI，16-32%），eGFR 小于 60 的 14%（95%CI，6-23%）和 ESRD 的 4%（95%CI，0-7%）。总体质量评估表明 RoB 为中度。
在儿科危重病幸存者的异质人群中，相当一部分幸存者患有 CKD 或 ESRD。本研究强调了报告诊断标准的重要性，更加重视危后护理监测和随访，以识别 CKD 患者。进一步的研究将有助于确定高危人群和改善结果的策略。
