Low birth weight and chronic kidney disease with progression to kidney failure in children.

Abstract

Background and hypothesis: It is unclear if 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 January 1, 2009, and December 31, 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 December 31, 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%), 6 843 infants with very low birth weight (1000 g to < 1500 g) (0.46%), and 4 349 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 (aHR 1.20, 95%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 to full-term infants.

Conclusion: We found children with LBW, preterm birth, or small for gestational age had a significantly increased risk of CKD and ESKD compared to children without intrauterine growth restriction.