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Association of antenatal corticosteroids with kidney function in adolescents born preterm with very low birth weight
Whitney N Floyd1, Daniel P Beavers2, Elizabeth T Jensen3
1Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA.
Insights
Antenatal corticosteroids (ANCS) did not worsen kidney function in adolescents. However, ANCS may be linked to lower estimated glomerular filtration rate (eGFR) in those who develop obesity.
Area of Science:
- Neonatal medicine
- Pediatric nephrology
- Adolescent health
Background:
- Antenatal corticosteroids (ANCS) are crucial for preterm infant lung maturation.
- The long-term effects of ANCS on adolescent kidney function, particularly in relation to adiposity, require further investigation.
Purpose of the Study:
- To determine if ANCS exposure is associated with impaired kidney function in adolescence.
- To examine whether increased adiposity magnifies any potential association between ANCS and kidney function.
Main Methods:
- A prospective cohort study of 162 adolescents born preterm with very low birth weight (<1500g).
- Kidney function assessed by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).
- Analyses stratified by waist-to-height ratio (WHR) to assess adiposity, using adjusted generalized linear models.
Main Results:
- No significant association was found between ANCS exposure and eGFR or UACR in the overall cohort.
- A significant interaction was observed: ANCS was associated with lower eGFR in adolescents with a WHR ≥ 0.5 (indicating greater adiposity).
- Specifically, ANCS was linked to a decrease of -16.8 ml/min/1.73 m² in eGFR for adolescents with higher adiposity (p=0.02 for interaction).
Conclusions:
- ANCS exposure alone does not appear to negatively impact adolescent kidney function.
- However, ANCS may be associated with reduced eGFR in adolescents who develop obesity, highlighting the importance of monitoring adiposity in this population.
Objective:
Investigate if antenatal corticosteroids (ANCS) are associated with worse kidney function in adolescence and if greater adiposity magnifies this association.
Study Design:
Prospective cohort of 162 14-year-olds born preterm with very low birth weight (<1500 g). Outcomes were estimated glomerular filtration rate (eGFR) and first-morning urine albumin-to-creatinine ratio (UACR). We used adjusted generalized linear models, stratified by waist-to-height ratio (WHR) ≥ 0.5.
Results:
Fifty-five percent had ANCS exposure and 31.3% had WHR ≥ 0.5. In adjusted analyses of the entire cohort, ANCS was not significantly associated with eGFR or UACR. However, the ANCS-eGFR association was greater in those with WHR ≥ 0.5 (β -16.8 ml/min/1.73 m2, 95% CL -31.5 to -2.1) vs. WHR < 0.5: (β 13.9 ml/min/1.73 m2, 95% CL -0.4 to 28.1), interaction term p = 0.02.
Conclusion:
ANCS exposure was not associated with worse kidney function in adolescence, though ANCS may be associated with lower eGFR if children develop obesity by adolescence.
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