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Published on: March 11, 2016
Renal dysfunction is already evident within the first month of life in Australian Indigenous infants born preterm
Megan R Sutherland1, Mark D Chatfield2, Belinda Davison2
1Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia.
Insights
Preterm birth impacts kidney function in Australian Indigenous infants, increasing their risk for chronic kidney disease. Lifelong renal monitoring is recommended for these vulnerable children.
Area of Science:
- Nephrology
- Public Health
- Indigenous Health
Background:
- Australian Indigenous peoples experience high rates of chronic kidney disease.
- Preterm birth (under 37 weeks gestation) is common in Australian Indigenous infants (14%) and poses a risk factor for kidney issues.
- Early life factors may contribute to the disproportionate burden of kidney disease in this population.
Purpose of the Study:
- To investigate the impact of preterm birth on early-life renal function in Australian Indigenous and non-Indigenous infants.
- To identify specific markers of renal dysfunction and injury in preterm infants based on ethnicity.
Main Methods:
- Observational cohort study comparing renal function in preterm Australian Indigenous (n=60) and non-Indigenous (n=42) infants.
- Renal function assessed between 4-29 days postnatally using serum creatinine, fractional excretion of sodium, and urine biomarkers (albumin, β-2 microglobulin, cystatin C, neutrophil gelatinase-associated lipocalin).
- Statistical analysis controlled for gestational age, postnatal age, sex, and birth weight Z-score.
Main Results:
- Indigenous infants exhibited significantly impaired renal function, indicated by higher serum creatinine, fractional excretion of sodium, urine albumin, β-2 microglobulin, and cystatin C.
- Elevated urine neutrophil gelatinase-associated lipocalin (a marker of renal injury) was linked to maternal smoking and postnatal antibiotic exposure.
- Indigenous infants showed increased susceptibility to the adverse renal effects of antibiotics.
Conclusions:
- Preterm Australian Indigenous infants are highly vulnerable to renal dysfunction.
- Preterm birth is a significant contributing factor to the increased risk of chronic kidney disease in this population.
- Lifelong monitoring of renal function is crucial for Indigenous children born preterm.
Abstract:
Antecedents of the high rates of chronic kidney disease in Australian Indigenous peoples may originate early in life. Fourteen percent of Australian Indigenous infants are born preterm (under 37 weeks gestation) and, therefore, at risk. Here, our observational cohort study sought to determine the impact of preterm birth on renal function in Australian Indigenous and non-Indigenous infants. Renal function was assessed between 4-29 days postnatally in 60 Indigenous and 42 non-Indigenous infants born at 24-36 weeks gestation. Indigenous ethnicity was associated with impaired renal function, with significantly higher serum creatinine (geometric mean ratio (GMR) 1.15 [1.06, 1.25]), fractional excretion of sodium (GMR 1.21 [1.04, 1.39]), and urine albumin (GMR 1.57 [1.05, 2.34]), β-2 microglobulin (GMR 1.82 [1.11, 2.98]) and cystatin C (GMR 3.27 [1.54, 6.95]) when controlling for gestational/postnatal age, sex and birth weight Z-score. Renal injury, as indicated by high urine neutrophil gelatinase-associated lipocalin levels, was associated with maternal smoking and postnatal antibiotic exposure. Indigenous infants appeared to be most susceptible to the adverse impact of antibiotics. These findings show that preterm Australian Indigenous infants are highly vulnerable to renal dysfunction. Preterm birth may contribute to their increased risk of chronic kidney disease. Thus, we recommended that renal function should be closely monitored life-long in Indigenous children born preterm.
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