Extremely Low Birth Weight Predisposes to Impaired Renal Health: A Pooled Analysis

Abstract

Background: A number of studies examined the association between preterm delivery and kidney size and function later in life. However, the number of cases in published cohort studies is low. This study was aimed at performing a multicenter collaboration to pool data to obtain more accurate results to quantify the extent of renal impairment in former extremely low birth weight (ELBW; <1,000 g) children. Methodology: We performed a subject-level meta-analysis to pool data from Cracow (64 cases/34 controls) and Leuven (93 cases/87 controls). We assessed and analyzed cystatin C, estimated glomerular filtration rate (eGFR), ultrasound kidney length, and blood pressure (BP) in 11-year-old ELBW children compared with controls born at term. The prevalence of hypertension (HT) and prehypertension (preHT) in both groups was also analyzed. Results: The study group comprised 157 former ELBW children (gestational age 23–33 weeks and birth weight 430–1,000 g) and 123 children born at term. Former ELBW children had lower mean eGFR (100.62 ± 16.53 vs. 111.89 ± 15.26 mL/min/1.73 m2; p < 0.001), smaller absolute kidney length (8.56 ± 0.78 vs. 9.008 ± 0.73 cm; <0.001), and higher systolic (111.8 ± 9.8 vs. 107.2 ± 9.07 mm Hg; p = 0.01) and diastolic (68.6 ± 6.8 vs. 66.3 ± 7.7 mm Hg; p = 0.03) BP. Smaller renal size in former ELBW children was positively associated with lower birth weight, shorter gestational age, and severity of perinatal complications (intraventricular hemorrhage, length of stay, mechanical ventilation, and oxygen therapy). Conclusion: ELBW is associated with lower eGFR and a high frequency of preHT and HT.

The Long-Term Effect of Preterm Birth on Renal Function: A Meta-Analysis

“…In this meta-analysis, blood pressure was investigated by several studies [8,[24][25][26][27][29][30][31][32][33][37][38][39][40][41]43,44,[46][47][48], and the results were uniform in that the preterm-born group had higher SBP and DBP both in single-time and ambulatory monitored measures. These results were consistent with the previous meta-analyses [59][60][61][62]. Although SGA and AGA were not distinguished for their difference in most of the previous studies, our study showed that higher blood pressure associated with preterm survivors was observed only in the SGA and not in the AGA group.…”

Renal Precision Medicine in Neonates and Acute Kidney Injury: How to Convert a Cloud of Creatinine Observations to Support Clinical Decisions

“…This matters, as in ELBW infants, exposure to nephrotoxic drugs is common (87%) with gentamicin (86%), indomethacin (43%), and vancomycin (25%) as most commonly administered drugs ( 62 ). It is hereby important to highlight that follow-up of these populations remains important after hospital discharge as there are concerns on the long-term renal outcome, most pronounced in former ELBW cases ( 63 ). Research should focus on perinatal risk factors associated with impaired GFR in long-term outcome studies, but is hampered by single center cohorts, small samples sizes, and heterogeneity of GFR assessment tools ( 64 ).…”

Glomerular Filtration Rate in Former Extreme Low Birth Weight Infants over the Full Pediatric Age Range: A Pooled Analysis

“…An obvious next step is to pool based on the individual data. Such an effort should also facilitate the exploration of the association between perinatal characteristics (like birth weight, small for gestational age (SGA), Apgar score, indomethacin/ibuprofen or steroid use or gestational age) and GFR outcome, similar to the effort recently reported to pool the ELBW renal outcome data at the age of 11 years [22]. Second and at least as relevant, such pooling effort needs to consider the heterogeneity in GFR measurement (inulin, cystatin C or creatinine estimated GFR formulae) tools and assays (cystatin C, creatinine) used [6,22].…”