Researchers identify risk factors for kidney disease among low gestational age neonates
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Among extremely low gestational age neonates, gestational age, birthweight z-score and prenatal steroids correlated with an increased risk for chronic kidney disease.
“The risk factors and natural history for CKD progression in infants and children is poorly understood,” Sangeeta R. Hingorani, MD, MPH, an attending physician at Seattle Children’s Hospital and an associate professor of pediatrics at the University of Washington School of Medicine, and colleagues wrote. They added, “Questions remain regarding the independent effect of prematurity, low birth weight or extrauterine events (ie, AKI) on long-term kidney disease. Additionally, timing of development of kidney abnormalities in extremely low gestational age neonates and when and in whom to begin screening has not been determined.”
In the Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study, researchers evaluated the kidney outcomes of 923 neonates enrolled in the Preterm Epo Neuroprotection Trial (PENUT) study.
Researchers measured kidney function, urine albumin and blood pressure at protocol-specific times during the hospital course and then at the 2-year corrected gestational age. Kidney outcomes were examined across gestational age categories. Additionally, researchers explored the relationship between kidney-related outcomes and neonatal and maternal characteristics.
Development of CKD was considered the primary outcome of the study.
Of the 923 neonates, 832 survived to 2 years. However, 565 neonates were included in the final analysis because other patients lacked at least one measured outcome. Analyses revealed 53% had one abnormal kidney outcome, 18% had an eGFR of less than 90 mL/min per 1.73 m2, 36% had albuminuria, 22% had elevated systolic blood pressure and 44% had elevated diastolic blood pressure.
Researchers observed a correlation between gestational age, birth weight z-score and prenatal steroids with an eGFR of less than 90 mL/min per 1.73 m2. Similarly, an elevated systolic blood pressure was linked with indomethacin use and Black race, whereas elevated diastolic blood pressure correlated with men, severe AKI and indomethacin use.
“These findings have important implications for long-term care and management of premature infants and emphasize the need for neonatologists and nephrologists to discuss the risk of kidney issues and elevated blood pressure with family members and health care providers before discharge from the neonatal intensive care unit,” Hingorani and colleagues wrote. They added, “We suggest screening all extremely low gestational age neonates with a serum creatinine and cystatin C, a urine collected for an albumin-creatinine ratio, and a blood pressure measured at approximately 2 years of age. Those with abnormal findings should have repeat measurements and follow-up with a nephrologist.”
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