Low birth weight and chronic kidney disease with progression to kidney failure in children.

Background: It is unclear whether low birth weight (LBW), preterm birth and small for gestational age (SGA) could synergistically cause chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This cohort study was conducted to examine their individual and combined impacts on the development of CKD and ESKD in childhood.

Methods: From the Taiwan Maternal and Child Health Database, we identified 1 477 128 newborns born between 1 January 2009 and 31 December 2016. We used a multivariable Cox regression model to assess the excess risk of CKD and ESKD in children with LBW/preterm/SGA. They were followed from birth until the occurrence of outcomes or until 31 December 2018, with an average follow-up of 5.78 years.

Results: This study included 1 361 071 infants with birth weight ≥2500 g (92.14%), 104 855 infants with low birth weight (1500 g to <2500 g) (7.10%), 6843 infants with very low birth weight (1000 g to <1500 g) (0.46%) and 4349 infants with extremely low birth weight (<1000 g) (0.29%). The multivariable-adjusted model showed that male infants with low birth weight were associated with an increased risk of CKD [adjusted hazard ratio (aHR) 1.20, 95% confidence interval (CI) 1.08-1.32] and ESKD (aHR 1.64, 95% CI 1.37-1.97). Female infants with LBW had an increased risk of CKD (aHR 1.18, 95% CI 1.06-1.32) and ESKD (aHR 1.31, 95% CI 1.09-1.58) than those without LBW. In addition to LBW, infants with preterm or SGA condition also had a significantly and synergistically increased risk of CKD and ESKD compared with full-term infants.

Conclusion: We found children with LBW, preterm birth or SGA had a significantly increased risk of CKD and ESKD compared with children without intrauterine growth restriction.