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Published on: June 29, 2013
Association Between Intrauterine Growth Restriction and Chronic Kidney Disease: A Birth Cohort Study Analysis
Daniela Aparecida Lorencini1, Paulo Cesar Lopes1, Heloísa Bettiol2
1Internal Medicine Department, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
Rationale & Objective:
Diabetes mellitus and hypertension are the main risk factors for chronic kidney disease (CKD), but factors affecting fetal development also contribute to later kidney loss. Various birth-related factors and definitions, including low birth weight (LBW), intrauterine growth restriction (IUGR), and prematurity, complicate the understanding of this relationship. Therefore, this study aimed to evaluate the effect of these fetal conditions on the risk of CKD by the end of the third decade of life.
Study Design:
A single-center, birth cohort study.
Setting & Participants:
The cohort was established between 1978 and 1979 in Brazil, which included 6,827 newborns (98% of births). The follow-up visit occurred in 2016/2017, and 1,564 participants were included in the study.
Exposure:
Prematurity (gestational age < 37 weeks), LBW (<2,500 g), and IUGR defined as body weight ratio ≤0.85.
Outcomes:
The primary outcome was the presence of CKD. Secondary outcomes were the values of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR).
Analytical Approach:
eGFR was modeled using multivariable linear regression. UACR was analyzed using a quantile regression (median) model. CKD risk was estimated using a logistic regression model to calculate the odds ratio (95% CI).
Results:
Prematurity was associated with a lower eGFR (105.9 ± 13.1 vs 108.8 ± 13.0 mL/min/1.73 m2, P < 0.05), while IUGR was linked to a higher prevalence of CKD (25.3% vs 18.1%, P < 0.05). In multivariate analysis, factors such as body mass index, homocysteine level, C-reactive protein level, and UACR were associated with lower eGFR. Female sex, high blood pressure, glycated hemoglobin levels, C-reactive protein levels, and pulse wave velocity were associated with increased UACR. None of the birth exposure factors impacted eGFR or UACR. IUGR (1.50 [1.10-2.21], P = 0.047), diabetes mellitus (1.60 [1.05-2.46], P = 0.03), and female sex (2.18 [1.62-2.90]) were associated with an increased risk of CKD. Neither LBW nor prematurity shows significant associations with CKD risk.
Limitations:
The cohort design, with participant loss because of dropouts during the follow-up visits.
Conclusions:
IUGR was associated with a higher risk of CKD, particularly in women.
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