Increased carotid intima-media thickness in pediatric nephrotic syndrome: A meta-analysis

Nephrotic syndrome (NS) in children has been associated with an increased risk of early atherosclerosis, as indicated by carotid intima-media thickness (cIMT). However, the existing literature on the relationship between NS and cIMT in pediatric populations presents inconsistent findings. This meta-analysis aims to compare cIMT measurements between children with NS and healthy controls. A comprehensive search of PubMed, Embase, and Web of Science was conducted through May 22, 2025. Observational studies that compared cIMT in children under 18 years with NS against controls were included. Mean differences (MDs) with 95% confidence intervals (CIs) were aggregated using a random-effects model to account for potential heterogeneity. Thirteen case-control studies involving 578 children with NS and 741 controls were analyzed. The results indicated that children with NS had significantly higher cIMT compared to controls (MD: 0.06 mm; 95% CI: 0.04-0.08; p < 0.001; I² = 68%). Subgroup analyses revealed that the difference in cIMT was notably larger in studies with ≥ 60% male participants (MD: 0.09 mm) compared to those with < 60% males (MD: 0.03 mm; p for subgroup difference = 0.01). No significant differences were observed based on age, disease duration, or adjustments for body mass index, blood pressure, or lipid profile (all p > 0.05). Meta-regression analyses suggested that the proportion of male participants and the rate of steroid-resistant nephrotic syndrome (SRNS) may contribute to observed heterogeneity (adjusted R² = 29.8% and 22.5%, respectively), although the slopes for these meta-regressions were not statistically significant (p = 0.13 and 0.87). In conclusion, children with NS exhibit increased cIMT compared to controls, indicating early vascular changes. The predominance of males and the presence of SRNS may partially account for the heterogeneity observed across studies.