Perinatal factors contributing to chronic kidney disease in a cohort of Japanese children with very low birth weight

Osamu Uemura,Naoya Fujita,Naoaki Mikami,Daishi Hirano,Tetsuji Kaneko,Satoshi Hibino,Takeshi Sahashi,Yuko Hamasaki,Yoshimitsu Gotoh,Masataka Honda,Masaki Yamamoto,Kenji Ishikura,Masaru Nakano,Yasuhiro Wakano,Masao Ogura

doi:10.1007/s00467-020-04791-1

Abstract

BackgroundDevelopmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR?MethodsThis is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age ≥ 3 years. A structural equation model was used to examine the pathologic constitution.ResultsThe 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 ± 2.6 years and mean eGFR 111.7 ml/min/1.73 m2 at last encounter. Pathway analyses showed intrauterine malnutrition (β = 0.85) contributed more to chronic kidney damage than stress during the neonatal period (β = − 0.19) and prematurity (β = 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period.ConclusionsIUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life.

Highlights

Intrauterine growth restriction (IUGR), low birth weight (LBW), and premature birth have causal relationships to the origins of hypertension, coronary heart disease, and non-insulin-dependent diabetes in men and women [1, 2]
Factors recorded for each patient during the perinatal or neonatal period included date of birth, sex, gestational age, birth weight and height, maternal age, maternal smoking, gravidity, maternal steroid administration, 5-min Apgar score, pH, respiratory distress syndrome, artificial breathing management period, patent ductus arteriosus, doses of indomethacin, late-onset circulatory collapse treated with corticosteroids, kidney dysfunction in neonatal period, duration of treatment with antibiotics and diuretics, and duration of enteral feeding
446 very low birth weight (VLBW) children, 253 boys and 193 girls, who fulfilled the eligibility criteria were included in this study (Fig. 1)

Summary

Introduction

Intrauterine growth restriction (IUGR), low birth weight (LBW), and premature birth have causal relationships to the origins of hypertension, coronary heart disease, and non-insulin-dependent diabetes in men and women [1, 2]. These associations were shown to be independent of the duration of gestation and must be the result of slow fetal growth [3,4,5,6,7,8]. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life

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Conclusion