Pediatric Postoperative Acute Kidney Injury After Noncardiac Surgery: A Systematic Review and Meta-Analysis.

IF 1.6 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2026-11-01 Epub Date: 2026-08-18 DOI:10.1002/pan.70284

Arash Emami, Ebba Sivertsson, Johan Westerbergh, Michael Marks-Hultström, Johan Danielsson, Peter Frykholm, Robert Frithiof

{"title":"Pediatric Postoperative Acute Kidney Injury After Noncardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Arash Emami, Ebba Sivertsson, Johan Westerbergh, Michael Marks-Hultström, Johan Danielsson, Peter Frykholm, Robert Frithiof","doi":"10.1002/pan.70284","DOIUrl":null,"url":null,"abstract":"Background: Postoperative acute kidney injury (AKI) is associated with substantial morbidity and mortality. Reliable estimates of AKI after surgery in children are lacking. To address this gap, we aimed to synthesize the available evidence on the incidence of AKI after pediatric noncardiac surgery.Methods: We searched PubMed, Cochrane and Web of Science for studies reporting the incidence of AKI, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, within 7 postoperative days. Observational studies and clinical trials including patients aged < 18 years were eligible. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results: Twenty-seven studies (n = 21 908) were included. Considerable heterogeneity (I2 = 98.7%) and likely overrepresentation of clinically distinct high-risk populations limited the interpretability of a single overall pooled incidence estimate. The incidence was 22.3% (95% CI, 11.2-39.3) after neonatal surgery, 30.1% (95% CI, 21.4-40.6) after pediatric liver transplantation, and 9.2% (95% CI, 3.3-23.6) in mixed pediatric surgical populations. The certainty of evidence was rated low to very low. In mixed pediatric surgical populations, AKI incidence increased from 2.4% in American Society of Anesthesiologists (ASA) class 1-2 to 7.5% in ASA 3 (p < 0.001) and 18.9% in ASA 4-5 (p < 0.001), and decreased from 9.8% at 0-2 years to 4.0% at 12-18 years (p < 0.001).Conclusion: The reported incidence of postoperative AKI in children undergoing noncardiac surgery remains uncertain due to substantial heterogeneity and overrepresentation of high-risk populations. AKI incidence was high in neonates and liver transplant recipients and was associated with younger age and higher ASA class, although data were limited. Further prospective studies in broader pediatric surgical populations are needed to better assess the risk of postoperative AKI in children.Trial registration: PROSPERO registration no.: CRD42024518832.","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1387-1399"},"PeriodicalIF":1.6000,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639225/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pan.70284","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/18 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Postoperative acute kidney injury (AKI) is associated with substantial morbidity and mortality. Reliable estimates of AKI after surgery in children are lacking. To address this gap, we aimed to synthesize the available evidence on the incidence of AKI after pediatric noncardiac surgery.

Methods: We searched PubMed, Cochrane and Web of Science for studies reporting the incidence of AKI, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, within 7 postoperative days. Observational studies and clinical trials including patients aged < 18 years were eligible. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Twenty-seven studies (n = 21 908) were included. Considerable heterogeneity (I² = 98.7%) and likely overrepresentation of clinically distinct high-risk populations limited the interpretability of a single overall pooled incidence estimate. The incidence was 22.3% (95% CI, 11.2-39.3) after neonatal surgery, 30.1% (95% CI, 21.4-40.6) after pediatric liver transplantation, and 9.2% (95% CI, 3.3-23.6) in mixed pediatric surgical populations. The certainty of evidence was rated low to very low. In mixed pediatric surgical populations, AKI incidence increased from 2.4% in American Society of Anesthesiologists (ASA) class 1-2 to 7.5% in ASA 3 (p < 0.001) and 18.9% in ASA 4-5 (p < 0.001), and decreased from 9.8% at 0-2 years to 4.0% at 12-18 years (p < 0.001).

Conclusion: The reported incidence of postoperative AKI in children undergoing noncardiac surgery remains uncertain due to substantial heterogeneity and overrepresentation of high-risk populations. AKI incidence was high in neonates and liver transplant recipients and was associated with younger age and higher ASA class, although data were limited. Further prospective studies in broader pediatric surgical populations are needed to better assess the risk of postoperative AKI in children.

Trial registration: PROSPERO registration no.: CRD42024518832.

查看原文本刊更多论文

儿童非心脏手术后急性肾损伤：系统回顾和荟萃分析。

背景：术后急性肾损伤（AKI）与大量的发病率和死亡率相关。缺乏对儿童手术后AKI的可靠估计。为了解决这一差距，我们旨在综合有关儿科非心脏手术后AKI发生率的现有证据。方法：我们检索了PubMed、Cochrane和Web of Science中报告AKI发生率的研究，AKI的定义根据肾脏疾病：改善总体预后（KDIGO）标准，在术后7天内。结果：纳入27项研究（n = 21 908）。相当大的异质性（I2 = 98.7%）和可能的临床不同高危人群的过度代表限制了单一总体合并发病率估计的可解释性。新生儿手术后的发生率为22.3% (95% CI, 11.2-39.3)，小儿肝移植后的发生率为30.1% (95% CI, 21.4-40.6)，混合小儿手术人群的发生率为9.2% （95% CI, 3.3-23.6）。证据的确定性被评为低至极低。在混合儿科手术人群中，AKI发病率从美国麻醉医师学会（ASA） 1-2级的2.4%上升到ASA 3级的7.5% (p)。结论：由于存在很大的异质性和高风险人群的过度代表，报道的非心脏手术儿童术后AKI发病率仍然不确定。尽管数据有限，但新生儿和肝移植受者的AKI发生率较高，且与年龄较小和ASA等级较高相关。需要在更广泛的儿科手术人群中进行进一步的前瞻性研究，以更好地评估儿童术后AKI的风险。试用注册：普洛斯彼罗注册号。: CRD42024518832。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.