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Low birth weight and chronic kidney disease with progression to kidney failure in children
Fu-Shun Yen1, James Cheng-Chung Wei2,3,4,5, Wan-Yin Cheng6
1Dr Yen's Clinic, Taoyuan, Taiwan.
Insights
Low birth weight (LBW), preterm birth, and small for gestational age (SGA) significantly increase children's risk for chronic kidney disease (CKD) and end-stage kidney disease (ESKD). These factors, especially when combined, pose a synergistic threat to kidney health in early life.
Area of Science:
- Pediatric Nephrology
- Perinatal Medicine
- Public Health
Background:
- The independent and combined effects of low birth weight (LBW), preterm birth, and small for gestational age (SGA) on the development of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in childhood remain unclear.
- Intrauterine growth restriction and premature birth are known risk factors for various adverse health outcomes, but their specific impact on long-term kidney function requires further investigation.
Purpose of the Study:
- To investigate the individual and synergistic impacts of LBW, preterm birth, and SGA on the risk of developing CKD and ESKD in children.
- To quantify the excess risk associated with these perinatal conditions using a large-scale cohort study.
Main Methods:
- A cohort study utilizing the Taiwan Maternal and Child Health Database, including 1,477,128 newborns born between 2009 and 2016.
- Multivariable Cox regression models were employed to assess the risk of CKD and ESKD.
- Infants were followed from birth until December 31, 2018, with an average follow-up of 5.78 years.
Main Results:
- Low birth weight (LBW) was associated with an increased risk of CKD and ESKD in both male and female infants.
- Male infants with LBW showed aHR of 1.20 for CKD and 1.64 for ESKD.
- Preterm birth and SGA conditions, in addition to LBW, demonstrated a significant and synergistic increase in the risk of CKD and ESKD compared to full-term infants.
Conclusions:
- Children born with LBW, preterm birth, or SGA face a significantly elevated risk of developing CKD and ESKD.
- These perinatal factors contribute to long-term kidney disease risk, highlighting the importance of monitoring and potential interventions for affected children.
Background:
It is unclear whether low birth weight (LBW), preterm birth and small for gestational age (SGA) could synergistically cause chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This cohort study was conducted to examine their individual and combined impacts on the development of CKD and ESKD in childhood.
Methods:
From the Taiwan Maternal and Child Health Database, we identified 1 477 128 newborns born between 1 January 2009 and 31 December 2016. We used a multivariable Cox regression model to assess the excess risk of CKD and ESKD in children with LBW/preterm/SGA. They were followed from birth until the occurrence of outcomes or until 31 December 2018, with an average follow-up of 5.78 years.
Results:
This study included 1 361 071 infants with birth weight ≥2500 g (92.14%), 104 855 infants with low birth weight (1500 g to <2500 g) (7.10%), 6843 infants with very low birth weight (1000 g to <1500 g) (0.46%) and 4349 infants with extremely low birth weight (<1000 g) (0.29%). The multivariable-adjusted model showed that male infants with low birth weight were associated with an increased risk of CKD [adjusted hazard ratio (aHR) 1.20, 95% confidence interval (CI) 1.08-1.32] and ESKD (aHR 1.64, 95% CI 1.37-1.97). Female infants with LBW had an increased risk of CKD (aHR 1.18, 95% CI 1.06-1.32) and ESKD (aHR 1.31, 95% CI 1.09-1.58) than those without LBW. In addition to LBW, infants with preterm or SGA condition also had a significantly and synergistically increased risk of CKD and ESKD compared with full-term infants.
Conclusion:
We found children with LBW, preterm birth or SGA had a significantly increased risk of CKD and ESKD compared with children without intrauterine growth restriction.
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