Progression to chronic kidney disease in children with a history of preterm birth and neonatal stage 1 acute kidney injury

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ESPR273
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Abstract: :

BACKGROUND: Preterm birth is an independent risk factor for chronic kidney disease (CKD). As the majority of nephrogenesis occurs in the third trimester, preterm infants have a lower nephron endowment at birth and premature arrest of branching nephrogenesis shortly thereafter. Acute kidney injury (AKI) in the neonatal period further increases CKD risk. Early identification of CKD in children born preterm could enable informed dosing for renally-cleared medications, as well as prompt enhanced screening and intervention for comorbid cardiovascular disease, anemia, renal osteodystrophy, neurocognitive deficits and growth impairment.

OBJECTIVE: To identify the prevalence of early CKD in children with a history of premature birth and AKI.

DESIGN/METHODS: This prospective study evaluated renal function in ex-preterm children at 5-9 years of age. Subjects were recruited from a cohort of 357 VLBW infants born <30 weeks gestation between 2007 and 2013. This cohort had a 30% incidence of neonatal AKI. Subjects participated in a single study visit for serum collection as well as height, weight, and manual blood pressure (BP) measurements. First morning urine samples were also collected. Estimated GFR (eGFR) was determined using both the bedside (CKiDbed) and full (CKiDfull) Chronic Kidney Disease in Children equations. CKD was defined by eGFR <90 mL/min/1.73m2 and/or urine protein:creatinine (UPC) >0.2 and/or BP ≥95th percentile. Children with eGFR 90-99 mL/min/1.73m2 and/or UPC =0.2 were considered to have mild renal insufficiency. Univariate analyses compared perinatal and follow-up data from subjects with and without AKI history, and with and without current renal insufficiency by any definition. Regression analyses were used to model renal insufficiency as a function of AKI and other clinical risk factors.

RESULTS: 43 children (13 with stage 1 AKI and 30 with no AKI as neonates) participated in the study. There were no children with stage II or III neonatal AKI. Of the 43 children evaluated, 15 (35%) had clinical indices of renal insufficiency; 10 (23%) met criteria for CKD; the other 5 children had mild insufficiency concerning for evolving CKD. Small for gestational age (SGA) birth weight, and female sex were independent risk factors for renal insufficiency. In this small cohort, mild (stage I) neonatal AKI was not associated with renal insufficiency at age 5-9 years. CKiDbed significantly overestimated eGFR compared with the CKiDfull equation.

CONCLUSION(S): Independent of AKI history, there was a high prevalence of renal insufficiency in this school-age cohort of children born <30 weeks. Female sex and SGA may be independent risk factors for early CKD progression. Larger studies are needed to investigate the impact of neonatal AKI on long-term renal outcomes in the preterm population. Screening of high-risk populations should use the more sensitive CKiDfull equation for eGFR whenever possible.

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Cohen Children's Medical Center, Northwell Health
The Icahn School of Medicine at Mount Sinai
The Icahn School of Medicine at Mount Sinai
The Icahn School of Medicine at Mount Sinai
Cohen Children's Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell
Icahn School of Medicine at Mount Sinai
The Icahn School of Medicine at Mount Sinai

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