Late Kidney and Blood Pressure Outcomes after Pediatric Hematopoietic Stem-Cell Transplant: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Pediatric hematopoietic stem cell transplant (HSCT) recipients are at risk for late kidney and blood pressure (BP) outcomes, but existing literature on their prevalence is unclear and outcome assessments differ widely. We evaluated 1) the proportion of patients with late kidney and BP outcomes after pediatric HSCT; 2) the proportion of studies that assess AKI in the first 100-days post-HSCT; 3) kidney and BP outcome definition methods reported. Methods: Searched MEDLINE, Embase, CINAHL, Web of Science, and Scopus (January 2000–November 2022) for observational studies or clinical trials reporting kidney or BP outcomes, ≥6 months post-pediatric HSCT (excluded: N<20; conference abstracts; non-English/French). Categorical (e.g., CKD) and continuous (e.g., GFR) outcome measures were collected. Two reviewers independently reviewed articles, extracted data, and evaluated study quality; a third reviewer resolved disagreements. Stratified meta-analyses of pooled proportions were performed by HSCT indication (malignancy; non-malignancy; both) using a random-effects model. Heterogeneity was assessed; multiple sensitivity analyses were performed. Results: 12,333 references identified, 45 selected: 36/45(80.0%) and 20/45(44.4%) evaluated late kidney and BP outcomes, respectively; 18/45(40.0%) assessed AKI. Pooled proportions of patients with late kidney and BP outcomes: 15.0% [95% CI 0.11–0.20, I2=87.2%] and 9.0% [95% CI 0.06–0.13, I2=92.2%], respectively. Sensitivity analyses (removing different studies) showed similar estimates. Highest proportions were observed for the malignancy HSCT indication. There was significant heterogeneity in pooled estimates (all, p<0.05). GFR, albuminuria, and proteinuria were used to assess kidney function in 26(72.2%), 4(11.1%) and 4(11.1%) studies, respectively. Definitions for late kidney and BP outcomes were at times undefined and varied greatly. Conclusion: Late kidney and BP outcomes are common after pediatric HSCT, especially in malignancies, but the literature is exceedingly difficult to interpret. Future research should use well-defined kidney and BP outcome definitions with a goal to study data-driven interventions to reduce long-term kidney health burden. Funding: Government Support – Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.036 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.036 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".