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Clinical complications and anthropometric indicators of chronic kidney disease in a global context: scoping review
Virginia Maria Muniz1, Leticia de Paiva Souza Klippel2, Karla Laurindo Ferreira Freitas2
1Postgraduate Program in Nutrition and Health, Federal University of Espírito Santo, Av. Marechal Campos, 1468 (ou 1440), Campus de Maruípe, Vitória, Espírito Santo, 29040-090, Brazil. virginia.muniz@ufes.br.
Insights
This scoping review highlights significant disparities in pediatric chronic kidney disease (CKD) care between high-income countries and low- and middle-income countries (LMICs). Future research should focus on standardizing data and exploring access barriers in LMICs.
Area of Science:
- Nephrology
- Public Health
- Global Health Equity
Background:
- Pediatric chronic kidney disease (CKD) presents a substantial global health challenge, disproportionately affecting low- and middle-income countries (LMICs).
- Existing research indicates global disparities in CKD management, yet a comprehensive understanding of these differences in pediatric populations across continents is lacking.
Purpose of the Study:
- To conduct a scoping review of recent evidence on clinical complications and anthropometric indicators of childhood CKD.
- To identify knowledge gaps and inform future research directions for pediatric CKD globally.
Main Methods:
- A systematic search of major databases (PubMed/Medline, Embase, Web of Science, Google Scholar) was performed.
- Included studies were observational quantitative articles in English evaluating CKD in children aged 0-18 years.
- A scoping review methodology (Arksey and O'Malley, Levac et al., PRISMA-ScR) was employed to map existing literature.
Main Results:
- Fifteen studies met the inclusion criteria, analyzing data from 889 children in LMICs and 2564 in high-income countries (HICs).
- The review revealed clear inequalities in treatment access for pediatric CKD patients between HICs and LMICs.
Conclusions:
- Future research should prioritize standardizing variable definitions and measurements to reduce heterogeneity.
- Investigating barriers and facilitators to treatment access for children with CKD in LMICs is crucial.
- Developing large, multicenter collaborative cohorts for pediatric CKD in LMICs is recommended to generate more representative data and improve outcomes.
Background:
Pediatric chronic kidney disease (CKD) is a serious public health problem and represents a considerable burden on health systems, particularly in low- and middle-income countries (LMICs). Despite well-documented global disparities in CKD management, the extent of these differences across continents remains insufficiently explored, particularly in pediatric populations.
Objective:
To explore the body of recent evidence on clinical complications and anthropometric indicators of CKD in childhood and to identify gaps in knowledge that can guide the development of future studies of CKD in childhood, in the global context.
Data Sources:
Studies were searched in following electronic databases: PubMed/Medline, Embase, Web of Science, and Google Scholar.
Study Eligibility Criteria:
Inclusion criteria consisted of observational quantitative articles (cohort, cross-sectional, case-control studies) in English that evaluated CKD in children. We excluded studies without reported data findings, case studies with fewer than 50 individuals and conducted with the same cohort.
Participants And Interventions:
Children and adolescents aged 0 to 18 years old with CKD.
Study Appraisal And Synthesis Methods:
This research did not aim to evaluate the quality of individual studies, since the main objective of a scoping review is to map the evidence and identify strengths and weaknesses. We conducted a scoping review structured using the methodology developed by Arksey and O'Malley expanded by Levac et al. to map the existing literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) extension were adopted to increase methodological rigor. Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest.
Results:
Fifteen studies met inclusion criteria for this scoping review. Baseline clinical characteristics of individuals were analysed, with 889 from LMICs and 2564 from high-income countries (HICs). Inequality in access to treatment for pediatric patients with CKD between HICs and LMICs was evident.
Limitations:
Scoping reviews typically have limitations due to their broad research focus and lack of in-depth analysis of a specific problem; therefore, a meta-analysis is not possible. We limited the included studies to those published in English to avoid translation/interpretation errors. Finally, information biases may be present since the data were mostly extracted from observational studies based on secondary information sources.
Conclusions And Implications Of Key Findings:
Future studies should:1) Focus on standardizing variable definitions and measurement to reduce heterogeneity in the presentation of results; 2) Explore barriers and facilitators to access to treatment among of children with CKD from LMICs; 3) Promote the development of large multicenter collaborative cohorts of pediatric CKD in LMICs, enabling more representative data, longitudinal follow-up, and evidence-based strategies to improve outcomes.
Registration Number:
Open Science Framework protocol https://doi.org/10.17605/OSF.IO/Q4HN8.
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