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Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis
Davide Meneghesso1, Nicola Bertazza Partigiani1, Rachele Spagnol1
1Pediatric Nephrology, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy.
Insights
Nadir creatinine is a key predictor of long-term kidney health in infants with posterior urethral valves (PUVs). A creatinine level above 1 mg/dL indicates a higher risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Research
Background:
- Posterior urethral valves (PUVs) are a severe form of pediatric obstructive uropathy.
- PUVs can lead to chronic renal failure in up to 65% of cases and end-stage kidney disease (ESKD) in 8%-21% of patients.
- Improving long-term renal outcomes for PUV patients remains a critical challenge.
Purpose of the Study:
- To systematically review and meta-analyze the predictive value of postnatal nadir creatinine for long-term renal function in infants with PUVs.
- To assess the association between nadir creatinine levels and the development of chronic kidney disease (CKD) and ESKD.
- To identify reliable prognostic factors for better clinical management of PUV patients.
Main Methods:
- Systematic review and meta-analysis conducted according to PRISMA guidelines.
- Searched PubMed and Cochrane Library for studies published between January 2008 and June 2022.
- Analyzed data from 1,731 patients across 13 studies, with independent review and data extraction.
Main Results:
- Data from 1,731 infants with PUVs were analyzed, with a mean follow-up of 5.5 years.
- An average of 37.9% developed CKD and 13.6% developed ESKD.
- Patients with nadir creatinine above the 1 mg/dL cutoff had a 7.69-fold increased risk of developing CKD (95% CI: 2.35-25.17, p < 0.001).
Conclusions:
- Nadir creatinine is the most significant prognostic factor for long-term renal function in patients with PUVs.
- A nadir creatinine level exceeding 1 mg/dL is a significant predictor of CKD and ESKD risk.
- Further research is needed to refine nadir creatinine cutoffs and develop comprehensive risk stratification scores.
Background:
Posterior urethral valves (PUVs) represent the most severe pediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%-21% of patients. Unfortunately, renal outcomes have poorly improved over time. The key point is to identify patients at risk; thus, several prenatal and postnatal prognostic factors have been analyzed to improve clinical outcomes. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding.
Objective:
We performed a systematic review with meta-analysis to analyze the predictive value of nadir creatinine on long-term renal function in infants with PUVs.
Methods:
We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps.
Results:
A total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analyzed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35-25.17, I 2 = 92.20%, p < 0.001).
Conclusions:
Nadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.
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