Preterm birth and kidney disease: the risk

“Preterm birth (<37 gestational weeks) interrupts the development and maturation of the kidneys during a critical growth period. The third trimester of pregnancy is the most active period of fetal nephrogenesis [development of the kidney], during which more than 60% of nephrons [the functional units of the kidney] are formed.” Interruption of this process results in a lower nephron number that is lifelong. “Lower nephron number has been associated with the development of hypertension and progressive kidney disease later in life.”

Based on this, does preterm birth lead “to a persistent increased risk of chronic kidney disease (CKD) into adulthood”?

Featured article:

Crump, C., Sundquist, J., Winkleby, M. A., & Sundquist, K. (2019). Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: National cohort study. BMJ (Clinical Research Ed.), 365, l1346. [PDF] [Cited by]

“Objective: To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood.

Design: National cohort study.

Setting: Sweden

Participants: 4,186,615 singleton live births in Sweden during 1973-2014.

Exposures: Gestational age at birth, identified from nationwide birth records in the Swedish birth registry.

Main outcome measures: CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors.

Results: 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood. An increased risk was observed even among those born at early term (37-38 weeks). The association between preterm birth and CKD was strongest at ages 0-9 years, then weakened but remained increased at ages 10-19 years and 20-43 years. These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.

Conclusions: Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.”

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