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 I 2 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%; I 2 = 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.