NYMC Faculty Publications

Prevalence and Risk Factors for Kidney Disease and Elevated BP in 2-Year-Old Children Born Extremely Premature

Sangeeta Hingorani, Division of Nephrology, Seattle Children's Hospital and University of Washington, Seattle, Washington.
Robert Schmicker, Department of Biostatistics, University of Washington, Seattle, Washington.
Kaashif A. Ahmad, University of Houston, College of Medicine and Gulf Coast Neonatology, Houston, Texas.
Ivan D. Frantz, Division of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Dennis E. Mayock, Division of Neonatology, Seattle Children's Hospital and University of Washington, Seattle, Washington.
Edmund F. La Gamma, Division of Newborn Medicine, Maria Fareri Children's Hospital Westchester Medical Center New York Medical College Valhalla, Valhalla, New York.Follow
Mariana Baserga, Division of Neonatology, University of Utah, Salt Lake City, Utah.
Janine Y. Khan, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, Illinois.
Maureen M. Gilmore, Neonatology Division, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Tonya Robinson, Division of Neonatology, University of Louisville, Louisville, Kentucky.
Patrick Brophy, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York.
Patrick J. Heagerty, Department of Biostatistics, University of Washington, Seattle, Washington.
Sandra E. Juul, Division of Neonatology, Seattle Children's Hospital and University of Washington, Seattle, Washington.
Stuart Goldstein, Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center and The University of Cincinnati College of Medicine, Cincinnati, Ohio.
David Askenazi, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.

Author Type(s)

Faculty

DOI

10.2215/CJN.15011121

Journal Title

Clinical Journal of the American Society of Nephrology

First Page

1129

Last Page

1138

Document Type

Article

Publication Date

8-1-2022

Department

Pediatrics

Abstract

BACKGROUND AND OBJECTIVES: Extremely low gestational age neonates born <28 weeks gestation are at risk for chronic disease. We sought to describe the prevalence of kidney outcomes by gestational age and determine risk factors for their development. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study examined kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo NeuroProtection Trial (PENUT) study. Kidney function, urine albumin, and BP were measured at 2-year (24±2 months) corrected gestational age. We compared outcomes across gestational age categories and evaluated associations between kidney-related outcomes and neonatal and maternal characteristics. The primary outcome was eGFR <90 ml/min per 1.73 m (CKD); secondary outcomes were spot urine albumin-creatinine ratio ≥30 mg/g (albuminuria) and either systolic BP or diastolic BP >90th percentile for height, age, and sex. RESULTS: A total of 832 survived to 2 years, and 565 (68%) had at least one outcome measured. Overall, 297 (53%) had one abnormal kidney outcome; 61 (18%) had an eGFR <90 ml/min per 1.73 m, 155 (36%) had albuminuria, 65 (22%) had elevated systolic BP, and 128 (44%) had elevated diastolic BP. Gestational age (odds ratio, 0.94; 95% confidence interval, 0.89 to 0.99), birth weight -score (odds ratio, 0.92; 95% confidence interval, 0.85 to 0.98), and prenatal steroids (odds ratio, 1.23; 95% confidence interval, 1.08 to 1.39) were associated with an eGFR <90 ml/min per 1.73 m. An elevated systolic BP was associated with indomethacin use (odds ratio, 1.18; 95% confidence interval, 1.04 to 1.33) and Black race (odds ratio, 1.19; 95% confidence interval, 1.01 to 1.39); elevated diastolic BP was associated with male sex (odds ratio, 1.29; 95% confidence interval, 1.12 to 1.49), severe AKI (odds ratio, 1.24; 95% confidence interval, 1.04 to 1.48), and indomethacin use (odds ratio, 1.16; 95% confidence interval, 1.01 to 1.33). CONCLUSIONS: Approximately 18% of extremely low gestational age neonates have CKD, 36% have albuminuria, 22% have an elevated systolic BP, and 44% have an elevated diastolic BP at 2 years of age. Gestational age, birthweight -score, and prenatal steroids were associated with CKD. Male sex, Black race, indomethacin use, and severe AKI were associated with elevated BP. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_07_19_CJN15011121.mp3.

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