Exposure to famine in early life and chronic kidney diseases in adulthood

Chronic kidney disease (CKD) is an increasing contributor to the global disease burden. Previous findings indicated that exposure to famine in early life was associated with various metabolic diseases and urinary protein levels. We aimed to assess whether the exposure to China's Great Famine 1959-1962 during fetal or childhood period was associated with glomerular filtration rate (GFR) and risk of CKD (eGFR<60 mL/min per 1.73 m²) in adulthood.

SPECT-China was a population-based observational study in 2014-2015. Totally, 5124 women were included from SPECT-China study. Based on the birth year, they were divided into fetal-exposed (1959-1962), childhood-exposed (1949-1958), adolescence/young adult-exposed (1921-1948), and non-exposed (1963-1974, reference). The estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as eGFR less than 60 mL/min per 1.73 m².

Compared with the non-exposed, fetal exposure to famine was significantly associated with lower eGFR (B -1.47, 95%CI -2.81, -1.13) and greater risk of having CKD (OR 2.85, 95%CI 1.25, 6.50) in the crude model adjusting age. Further adjustments for demographic variables, body mass index, diabetes, and blood pressure did not qualitatively change the association (eGFR B -1.35, 95%CI -2.67, -0.04; CKD OR 2.42, 95%CI 1.05, 5.58). This association was not found in childhood-exposed and adolescence/young adult-exposed individuals.

Prenatal exposure to famine may have long-term effects on declined GFR and the development of CKD in humans. thus, fetal stage may be an important time window to prevent CKD in later life.