Zheng Xiaoying, Ren Yingying, Li Deyue, Lv Xueli, Wang Dongmei
Department of Nursing, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China.
School of Nursing, Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China.
Medicine (Baltimore). 2025 Sep 19;104(38):e44545. doi: 10.1097/MD.0000000000044545.
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.
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.
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.
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.
心血管疾病（CVD）和左心室肥厚（LVH）是儿科和青少年透析患者常见的并发症，会增加发病和死亡风险。尽管已有关于心血管风险的研究，但缺乏对其患病率及相关因素的系统综合分析。本研究旨在建立循证基础以指导临床干预。
我们系统检索了截至2025年3月的PubMed、Embase、Cochrane图书馆和Web of Science。对心血管事件和决定因素进行描述性分析，同时使用随机效应模型对LVH患病率进行荟萃分析。通过敏感性和亚组分析（按透析方式和研究质量分层）探索异质性来源，采用混合效应荟萃回归评估组间差异。使用纽卡斯尔-渥太华量表（NOS）评估观察性研究的质量，使用医疗保健研究与质量局检查表评估横断面研究的质量。用Cochran Q和I²统计量量化异质性。
最终分析纳入了10项观察性研究（5项队列研究，5项横断面研究），共6012例儿科和青少年透析患者（发表年份1996 - 2023年）。随机效应荟萃分析显示LVH合并患病率为56%（95%置信区间（CI）：44 - 69%；I² = 81.9%，P < 0.001），表明存在显著异质性。亚组分析显示，血液透析（HD）患者的LVH患病率在数值上高于腹膜透析（PD）患者（HD为66.0%，95% CI：52 - 78%；PD为51.5%，95% CI：38 - 65%），但差异无统计学意义（P = 0.204）。年龄、性别和HD方式是独立危险因素。女性患者心血管相关事件的发生率显著高于男性。
与对照组相比，儿科透析患者发生心血管事件和LVH的风险显著更高。这需要定期进行心脏超声初步监测、优化血压并进行风险分层。未来的多中心研究应：提供最佳透析方式；开展高质量研究以指导临床干预。
