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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.
Insights
Intrauterine growth restriction (IUGR) increases chronic kidney disease (CKD) risk, especially in women. Low birth weight and prematurity did not show significant associations with CKD risk in this birth cohort study.
Area of Science:
- Nephrology
- Developmental Biology
- Epidemiology
Background:
- Chronic kidney disease (CKD) is a major health concern, with diabetes and hypertension as primary risk factors.
- Fetal development factors, including low birth weight (LBW), intrauterine growth restriction (IUGR), and prematurity, are increasingly recognized as contributors to later-life kidney function decline.
- Understanding the long-term impact of these birth-related conditions is crucial for early intervention and prevention strategies.
Purpose of the Study:
- To investigate the association between fetal growth conditions (IUGR, LBW, prematurity) and the risk of developing CKD by the third decade of life.
- To evaluate the impact of these birth exposures on kidney function markers, specifically estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR).
Main Methods:
- A single-center birth cohort study was conducted in Brazil, enrolling 6,827 newborns between 1978-1979.
- Follow-up data from 1,564 participants in 2016-2017 were analyzed.
- Statistical models, including multivariable linear regression, quantile regression, and logistic regression, were used to assess the relationship between birth exposures and CKD outcomes.
Main Results:
- Intrauterine growth restriction (IUGR) was significantly associated with a higher prevalence of CKD (25.3% vs 18.1%) and increased CKD risk (OR 1.50 [1.10-2.21]).
- Prematurity was linked to a slightly lower eGFR, but neither LBW nor prematurity showed a significant association with CKD risk in multivariate analysis.
- Factors like female sex, high blood pressure, diabetes mellitus, and elevated C-reactive protein levels were associated with increased CKD risk or poorer kidney function markers.
Conclusions:
- Intrauterine growth restriction (IUGR) is a significant risk factor for developing chronic kidney disease (CKD) later in life, particularly in females.
- While prematurity and LBW were not directly linked to increased CKD risk in this cohort, IUGR highlights the critical role of fetal development in long-term kidney health.
- These findings underscore the importance of monitoring individuals with a history of IUGR for kidney function.
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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