White Sarah L, Perkovic Vlado, Cass Alan, Chang Choon Lan, Poulter Neil R, Spector Tim, Haysom Leigh, Craig Jonathan C, Salmi Isa Al, Chadban Steven J, Huxley Rachel R
The George Institute, Faculty of Medicine, University of Sydney, Sydney, Australia.
Am J Kidney Dis. 2009 Aug;54(2):248-61. doi: 10.1053/j.ajkd.2008.12.042. Epub 2009 Apr 1.
There has been considerable interest in the hypothesis that low birth weight may be a marker of impaired nephrogenesis and that this is causally related to chronic kidney disease (CKD).
Systematic review and meta-analysis of observational studies.
SETTING & POPULATION: Studies of the relationship between birth weight and CKD published before February 1, 2008, were identified by using electronic searches.
All studies that had collected data for birth weight and kidney function at greater than 12 months of age were eligible for inclusion, except for studies of extremely low-birth-weight infants, very premature infants, or toxic exposure in utero. STUDY FACTOR: Birth weight.
CKD defined as albuminuria, low estimated glomerular filtration rate (<60 mL/min/1.73 m(2) or < 10th centile for age/sex), or end-stage renal disease.
We analyzed 31 relevant cohort or case-control studies with data for 49,376 individuals and data for 2,183,317 individuals from a single record-linkage study. Overall, 16 studies reported a significant association between low birth weight and risk of CKD and 16 observed a null result. The combination of weighted estimates from the 18 studies for which risk estimates were available (n = 46,249 plus 2,183,317 from the record linkage study) gave an overall odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.44 to 2.08). Combined ORs were consistent in magnitude and direction for risks of albuminuria (OR, 1.81; 95% CI, 1.19 to 2.77), end-stage renal disease (OR, 1.58; 95% CI, 1.33 to 1.88), or low estimated glomerular filtration rate (OR, 1.79; 95% CI, 1.31 to 2.45).
A reliance on published estimates and estimates provided on request rather than individual patient data and the possibility of reporting bias.
Existing data indicate that low birth weight is associated with subsequent risk of CKD, although there is scope for additional well-designed population-based studies with accurate assessment of birth weight and kidney function and consideration of important confounders, including maternal and socioeconomic factors.
低出生体重可能是肾发生受损的一个标志,且这与慢性肾脏病(CKD)存在因果关系,这一假说引发了广泛关注。
对观察性研究进行系统评价和荟萃分析。
通过电子检索确定了2008年2月1日前发表的关于出生体重与CKD关系的研究。
所有收集了12个月龄以上出生体重和肾功能数据的研究均符合纳入标准,但极低出生体重儿、极早产儿或子宫内有毒物质暴露的研究除外。研究因素:出生体重。
CKD定义为蛋白尿、低估计肾小球滤过率(<60 mL/min/1.73 m²或低于年龄/性别的第10百分位数)或终末期肾病。
我们分析了31项相关队列研究或病例对照研究,涉及49376名个体的数据以及来自一项单一记录链接研究的2183317名个体的数据。总体而言,16项研究报告低出生体重与CKD风险之间存在显著关联,16项研究观察到无关联结果。对18项可获得风险估计值的研究(n = 46249加上记录链接研究中的2183317)的加权估计值进行合并,得出总体比值比(OR)为1.73(95%置信区间[CI],1.44至2.08)。蛋白尿风险(OR,1.81;95% CI,1.19至2.77)、终末期肾病风险(OR,1.58;95% CI,1.33至1.88)或低估计肾小球滤过率风险(OR,1.79;95% CI,1.31至2.45)的合并OR在大小和方向上是一致的。
依赖已发表的估计值以及根据要求提供的估计值,而非个体患者数据,且存在报告偏倚的可能性。
现有数据表明低出生体重与随后的CKD风险相关,尽管仍有必要开展更多精心设计的基于人群的研究,准确评估出生体重和肾功能,并考虑包括母亲因素和社会经济因素在内的重要混杂因素。