Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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European journal of pediatrics
Ambulatory hypertension and left ventricular hypertrophy in pediatric chronic kidney disease: a systematic review and meta-analysis
UNLABELLED: Cardiovascular disease is the leading cause of mortality in pediatric patients with chronic kidney disease (CKD). In the general pediatric population, hypertension is associated with an increased risk of left ventricular hypertrophy (LVH); however, the strength of this association varies in the pediatric CKD literature. A lack of consensus on optimal blood pressure (BP) targets for this population contributes to variability in clinical practice. This study aims to determine the association between ambulatory hypertension and LVH in pediatric CKD. A systematic literature search was conducted on five databases from 1974 to 2025. The mean left ventricular mass index (LVMI) and odds of LVH was compared between normotensive and hypertensive groups. The association between LVMI and 24-h systolic/diastolic blood pressure, day/night systolic/diastolic blood pressure, and 24-h mean arterial pressure (MAP), was determined. Fifty-one full text studies (n = 6509 children) were eligible for inclusion in the meta-analysis. Pediatric CKD patients with ambulatory hypertension demonstrated increased LVMI (mean difference 5.15 g/m2.7 (95% CI 3.16, 7.15) and increased risk of LVH odds ratio 2.82 (95% CI 2.18, 3.65) to normotensive controls. LVMI was significantly lower among children with a 24-h MAP < 50th percentile (- 8.2 g/m2.7, 95% CI - 16.0, - 0.4) and 24-h SBP between the 50 and 90th percentiles (- 10.8 g/m2.7, 95% CI - 20.8, - 0.8) compared to those with 24-h MAP or 24 h SBP > 90th percentile, respectively. CONCLUSION: In children with CKD, ambulatory hypertension is associated with elevated risk of LVH and increased LVMI. However, there was significant heterogeneity among the included studies with respect to study design and definition of outcomes. Timely detection of hypertensive target organ injury is imperative to mitigate future cardiovascular disease in pediatric CKD patients.Prospero Registration: CRD 42023426891. WHAT IS KNOWN: • Hypertension is a critical predictor of adverse cardiovascular outcomes in children with CKD. Hypertension-induced target organ damage such as LVH may predict future cardiovascular outcomes in high-risk populations. Despite this, there remains considerable variability in clinical blood pressure targets and monitoring practices. Our findings highlight the importance of ambulatory blood pressure monitoring (ABPM) in detecting subclinical cardiovascular injury, supporting its integration into routine CKD care to improve risk stratification and treatment decisions. WHAT IS NEW: • This meta-analysis establishes a robust association between ambulatory hypertension and left ventricular hypertrophy (LVH) in children with CKD, demonstrating that higher blood pressure burden is linked to increased left ventricular mass index (LVMI). Notably, children with 24-h mean arterial pressure (MAP) and systolic blood pressure (SBP) above the 90th percentile exhibited significantly greater LVMI, reinforcing the impact of sustained hypertension on cardiac remodelling in pediatric CKD. • The strong association between ambulatory hypertension and LVH underscores the urgent need for evidence-based BP thresholds that minimize cardiovascular risk in pediatric CKD. Early identification of hypertensive target organ damage may enable timely therapeutic interventions to prevent long-term cardiovascular complications. Future studies should focus on defining optimal BP targets and evaluating the efficacy of antihypertensive strategies tailored to pediatric CKD. Standardizing BP measurement approaches may further refine hypertension management and improve cardiovascular outcomes in this vulnerable population.
14 June 2026
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Post-asphyxia acute kidney injury in neonates: a systematic review
UNLABELLED: Perinatal asphyxia is a major cause of neonatal morbidity and mortality globally. It affects multi-systems and has significant renal consequences. Acute kidney injury (AKI) is a frequent complication of perinatal asphyxia; however, its burden, diagnosis, and outcomes remain variably characterized. This study employed a scoping review approach to map and synthesize the existing evidence on post-asphyxia AKI in neonates. A total of 30 studies published between 1995 and 2025 were included, encompassing different geographic regions, study designs, and diagnostic criteria. The review demonstrates a clear growth in scholarly attention to post-asphyxia AKI, particularly in the last 25 years, coinciding with the introduction of neonatal-modified KDIGO definitions and advances in neonatal nephrology. Reported incidence of AKI varied widely, ranging from 20% to over 60%, reflecting non-homogeneity in study populations, differing case definitions of acute kidney injury in neonates, the severities of hypoxic-ischemic encephalopathy, and varied methodological approaches. Findings consistently indicate that AKI is strongly associated with severe forms of perinatal asphyxia, the presence of multi-organ dysfunction, prolonged neonatal intensive care stay, and mortality. CONCLUSION: Despite emerging interest in novel biomarkers and standard definitions, important gaps persist in early detection, long-term renal outcome data, and evidence from low- and middle-income countries. Addressing these gaps through standardized monitoring, biomarker validation, and longitudinal follow-up will improve renal survival in neonates affected by perinatal asphyxia. WHAT IS KNOWN: • The newborn kidneys are susceptible to the hemodynamic changes that follow ischemia/asphyxia due to a poor functioning capacity and oftentimes an inadequate structural potential. • Neonatal AKI is closely linked to severe forms of asphyxia, increased length of hospital stay and increased mortality. its reported incidence is widely varied. WHAT IS NEW: • The emergence of novel biomarkers in the identification and diagnosis of neonatal AKI, and the uptake and application of standard definitions (modified neonatal KDIGO) in the identification of neonatal AKI. • The availabiltiy of specialized kidney support therapy (continuous kidney replacement therapy; the carpadiem) in the management of neonatal AKI.
11 May 2026
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