Perinatal factors contributing to chronic kidney disease in a cohort of Japanese children with very low birth weight
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ORIGINAL ARTICLE
Perinatal factors contributing to chronic kidney disease in a cohort of Japanese children with very low birth weight Osamu Uemura 1,2,3 & Kenji Ishikura 4,5 & Tetsuji Kaneko 6 & Daishi Hirano 7 & Yuko Hamasaki 8 & Masao Ogura 4 & Naoaki Mikami 9 & Yoshimitsu Gotoh 10 & Takeshi Sahashi 11 & Naoya Fujita 12 & Masaki Yamamoto 13 & Satoshi Hibino 12 & Masaru Nakano 14 & Yasuhiro Wakano 11 & Masataka Honda 9 Received: 3 June 2020 / Revised: 22 August 2020 / Accepted: 18 September 2020 # The Author(s) 2020
Abstract Background Developmental 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? Methods This 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, lateonset 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. Results The 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. Conclusions IUGR 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. Keywords Very low birth weight . Chronic kidney disease . Prematurity . Intrauterine growth restriction . Neonatal events . Maternal smoking
* Osamu Uemura [email protected] 1
2
Department of Clinical Medicine, Japanese Red Cross Toyota College of Nursing, Toyota, Japan Department of Pediatrics, Ichinomiya Medical Treatment & Habilitation Center, 1679-2 Tomida-nagaresuji, Ichinomiya-city, Aichi 494-0018, Japan
7
Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
8
Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
9
Department of Pediatric Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
10
Department of Pediatric Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, J
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