目的:儿科危重疾病的幸存者有长期器官后遗症的风险。慢性肾脏病(CKD)是与生长障碍相关的危重病(和ICU干预)的并发症,心血管疾病,和早逝。我们的目的是综合儿科危重病幸存者中CKD发病率的证据。
方法:MEDLINE,Embase,护理和相关健康文献的累积指数,和Cochrane受控试验登记册从开始到2024年2月。
方法:观察性研究报告了儿科危重病幸存者中从头CKD的发生率。
方法:两名评审员独立提取研究设计的数据,设置,人口,人口统计,诊断标准,和结果。
结果:Meta分析用于描述幸存者中CKD的发生率,使用乔安娜·布里格斯研究所工具评估的偏见风险(RoB),以及按等级评估的证据的强度和可靠性(建议的等级,评估,发展,和评估)。CKD量化为估计的肾小球滤过率(eGFR)小于90mL/min/1.73m2(结果1),eGFR小于60mL/min/1.73m2(结果2),和终末期肾病(ESRD)的eGFR小于15mL/min/1.73m2(结果3)。12项研究(3642例患者)符合选择标准,并报告了至少一项CKD的测量。中位随访时间为2年、3.6年和5年,分别,结果1、2和3。对于每个阈值,eGFR小于90的CKD发生率汇总估计值为24%(95%CI,16-32%),小于60的CKD发生率汇总估计值为14%(95%CI,6-23%),ESRD发生率汇总估计值为4%(95%CI,0-7%).总体质量评估表明RoB适中。
结论:在儿科危重病幸存者的异质人群中,重要的少数幸存者发展为CKD或ESRD。这项研究强调了诊断标准对报告的重要性,更加注重后重症监护监测和随访,以确定CKD患者。进一步的研究将有助于划分高风险群体和改善结果的战略。
OBJECTIVE: 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.
METHODS: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Register of Controlled Trials from inception to February 2024.
METHODS: Observational studies reporting the incidence of de novo CKD among survivors of pediatric critical illness.
METHODS: Two reviewers independently extracted data on study design, setting, population, demographics, diagnostic criteria, and outcome.
RESULTS: 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.
CONCLUSIONS: 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.