Abstract / Summary
Abstract Background Children and adolescents with chronic kidney disease (CKD) may experience abnormalities in muscle strength, muscle mass, nutritional status, and physical performance, but these outcomes are heterogeneous and incompletely characterized. Objective To systematically evaluate muscle strength, muscle mass, protein-energy wasting (PEW), sarcopenia-related traits, fatigue, balance, and physical performance in pediatric CKD and quantitatively synthesize comparable outcomes. Methods PubMed, Cochrane Library, and ScienceDirect were systematically searched for studies involving pediatric predialysis CKD, dialysis, or kidney transplantation. Outcomes were synthesized separately according to their clinical constructs. Random-effects meta-analyses were performed for sufficiently comparable outcomes using mean difference (MD), standardized mean difference (SMD), or pooled proportions with 95% confidence intervals (CI). This review was registered in PROSPERO (CRD420261464207). Results Eleven studies representing 1,422 renal-disease participants at the report level were included, with potential participant overlap between two CKiD-derived reports. The pooled prevalence of low handgrip strength was 67.2% (95% CI 57.2–76.0%). Compared with healthy controls, children with CKD had significantly lower handgrip strength (SMD − 0.44, 95% CI − 0.55 to − 0.32; I²=0%) and appendicular skeletal muscle mass index (MD − 1.62 kg/m², 95% CI − 1.98 to − 1.26; I²=0%). Quadriceps strength did not differ significantly between dialysis and transplant recipients (SMD − 0.26, 95% CI − 0.80 to 0.28; I²=0%). Other studies reported abnormalities in PEW, exercise capacity, gait, fatigue, balance, and sarcopenia-related traits, although definitions and measurement approaches varied substantially. Interpretation is limited by heterogeneous assessments, predominantly observational designs, potential confounding, and the small number of studies contributing to each meta-analysis. Conclusion Pediatric CKD is associated with measurable impairments in selected aspects of muscle health and physical function; however, standardized definitions and prospective studies are needed before firm screening or rehabilitation recommendations can be established.