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Prevalence and Risk Factors for Kidney Disease and Elevated BP in 2-Year-Old Children Born Extremely Premature

Sangeeta Hingorani1, Robert Schmicker2, Kaashif A Ahmad3

  • 1Division of Nephrology, Seattle Children's Hospital and University of Washington, Seattle, Washington.

Clinical Journal of the American Society of Nephrology : CJASN
|July 19, 2022
PubMed

Insights

Extremely low gestational age neonates face high risks of chronic kidney disease and elevated blood pressure by age two. Lower gestational age and birth weight are key risk factors for chronic kidney disease.

Area of Science:

  • Neonatal Medicine
  • Pediatric Nephrology
  • Public Health

Background:

  • Extremely low gestational age neonates (<28 weeks) are susceptible to chronic diseases.
  • Kidney outcomes in this population require further investigation.

Purpose of the Study:

  • To determine the prevalence of kidney outcomes in extremely low gestational age neonates.
  • To identify risk factors associated with these kidney outcomes.

Main Methods:

  • The Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study analyzed kidney function, albuminuria, and blood pressure at 2-year corrected gestational age.
  • Outcomes were compared across gestational age categories and linked to neonatal/maternal factors.
  • Primary outcome: estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m² (CKD); secondary outcomes: albuminuria and elevated blood pressure (BP).

Main Results:

  • Of 565 neonates with measured outcomes, 53% had at least one abnormal kidney outcome.
  • Prevalence: 18% CKD, 36% albuminuria, 22% elevated systolic BP, 44% elevated diastolic BP.
  • Risk factors for CKD included lower gestational age, lower birth weight z-score, and prenatal steroid use. Indomethacin use and Black race were linked to elevated systolic BP. Male sex, severe AKI, and indomethacin use were associated with elevated diastolic BP.

Conclusions:

  • 18% of extremely low gestational age neonates exhibit CKD by age two, with significant rates of albuminuria and elevated BP.
  • Gestational age, birth weight, and prenatal steroid use are associated with CKD.
  • Elevated BP is linked to male sex, Black race, indomethacin use, and severe AKI.
Abstract

Keywords:
albuminuriablood pressurechildrenchronic kidney diseaseepidemiology and outcomeshypertensionprematuritysystolic blood pressure

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