Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 17, Issue 8, Pages 1129-1138Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.15011121
Keywords
albuminuria; chronic kidney disease; hypertension; systolic blood pressure; prematurity; epidemiology and outcomes; children; blood pressure
Categories
Funding
- NIH National Institute of Diabetes and Digestive and Kidney Diseases-funded ancillary study [R01DK103608, U01 NS077953, U01 NS077955]
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Extremely low gestational age neonates are at risk for chronic disease, with approximately 18% having chronic kidney disease, 36% with albuminuria, 22% with elevated systolic blood pressure, and 44% with elevated diastolic blood pressure. Gestational age, birthweight z-score, and prenatal steroids are associated with chronic kidney disease, while indomethacin use, male sex, Black race, and severe acute kidney injury are associated with elevated blood pressure.
Background and objectives Extremely low gestational age neonates born < 28 weeks gestation are at risk for chronic disease. We sought to describe the prevalence of kidney outcomes by gestational age and determine risk factors for their development. Design, setting, participants, & measurements The Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study examined kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo NeuroProtection Trial (PENUT) study. Kidney function, urine albumin, and BP were measured at 2-year (24 +/- 2 months) corrected gestational age. We compared outcomes across gestational age categories and evaluated associations between kidney-related outcomes and neonatal and maternal characteristics. The primary outcome was eGFR < 90 ml/min per 1.73 m(2) (CKD); secondary outcomes were spot urine albumin-creatinine ratio >= 0 mg/g (albuminuria) and either systolic BP or diastolic BP > 90th percentile for height, age, and sex. Results A total of 832 survived to 2 years, and 565 (68%) had at least one outcome measured. Overall, 297 (53%) had one abnormal kidney outcome; 61 (18%) had an eGFR < 90 ml/min per 1.73 m(2), 155 (36%) had albuminuria, 65 (22%) had elevated systolic BP, and 128 (44%) had elevated diastolic BP. Gestational age (odds ratio, 0.94; 95% confidence interval, 0.89 to 0.99), birth weight z-score (odds ratio, 0.92; 95% confidence interval, 0.85 to 0.98), and prenatal steroids (odds ratio, 1.23; 95% confidence interval, 1.08 to 1.39) were associated with an eGFR < 90 ml/min per 1.73 m(2). An elevated systolic BP was associated with indomethacin use (odds ratio, 1.18; 95% confidence interval, 1.04 to 1.33) and Black race (odds ratio, 1.19; 95% confidence interval, 1.01 to 1.39); elevated diastolic BP was associated with male sex (odds ratio, 1.29; 95% confidence interval, 1.12 to 1.49), severe AKI (odds ratio, 1.24; 95% confidence interval, 1.04 to 1.48), and indomethacin use (odds ratio, 1.16; 95% confidence interval, 1.01 to 1.33). Conclusions Approximately 18% of extremely low gestational age neonates have CKD, 36% have albuminuria, 22% have an elevated systolic BP, and 44% have an elevated diastolic BP at 2 years of age. Gestational age, birthweight z-score, and prenatal steroids were associated with CKD. Male sex, Black race, indomethacin use, and severe AKI were associated with elevated BP.
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