Renal near-infrared spectroscopy for predicting acute kidney injury in pediatric cardiac surgery: A systematic review and meta-analysis

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Objective: Renal near-infrared spectroscopy (NIRS) is a non-invasive, real-time monitoring technique that measures regional renal oxygen saturation (rSO₂) and may enable early detection of renal hypoperfusion.This systematic review and meta-analysis aimed to evaluate the role of renal NIRS in predicting postoperative acute kidney injury (AKI) in pediatric patients undergoing cardiac surgery.Methods: A systemic search of PubMed, Cochrane Library, Google scholar and DOAJ database was conducted to identify relevant studies published between 2010 and 2024.The primary outcome was the pooled incidence of AKI.Secondary outcome included subgroup analyses based on AKI definition, geographic region, monitoring site, timing, side of monitoring and laterality.Heterogeneity was assessed using I² and Tau² statistics.Results: Eighteen studies comprising 1,330 participants were included.The pooled odds ratio (OR) for AKI was (OR-0.22;95% CI (confidence interval): 0.11 to 0.41; I²=92.1%;p<0.0001) indicating substantial heterogeneity.In the secondary outcome of subgroup analyses, the pooled odds ratio was higher in studies using KDIGO (Kidney Disease: Improving Global Outcomes) criteria (OR -0.54; 95% CI: 0.27 to 1.07) than in those using pRIFLE (Pediatric Risk, Injury, Failure, Loss and End) (OR -0.18; 95%CI: 0.06 to 0.44) criteria.In Asian studies, KDIGO-based estimates was OR -0.27 (95% CI: 0.20 to 0.35), while intraoperative monitoring estimates -OR -0.38 (95% CI: 0.15 to 0.96).Cerebral/renal site monitoring was associated with -OR -0.34; (95% CI: 0.18 to 0.63), and right-sided monitoring estimates -OR -0.20 (95% CI: 0.07-0.50).Conclusions: Renal NIRS identifies a clinically relevant pooled AKI incidence of 21 (6% approximately in postoperative pediatric cardiac surgery patients, with notable differences by definition, timing, and monitoring approach.Despite heterogeneity, these findings support to renal NIRS as a promising tool for early risk stratification and potential intervention to mitigate AKI.

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