Hsu Christine W, Yamamoto Kalani T, Henry Rohan K, De Roos Anneclaire J, Flynn Joseph T
Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Division of Nephrology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington;
Division of Nephrology, Department of Medicine, University of Hawaii, Honolulu, Hawaii;
J Am Soc Nephrol. 2014 Sep;25(9):2105-11. doi: 10.1681/ASN.2013060582. Epub 2014 Apr 17.
Development of CKD may be programmed prenatally. We sought to determine the association of childhood CKD with prenatal risk factors, including birth weight, maternal diabetes mellitus (DM), and maternal overweight/obesity. We conducted a population-based, case-control study with 1994 patients with childhood CKD (<21 years of age at diagnosis) and 20,032 controls in Washington state. We linked maternal and infant characteristics in birth records from 1987 to 2008 to hospital discharge data and used logistic regression analysis to assess the association of prenatal risk factors with childhood CKD. The prevalence of CKD was 126.7 cases per 100,000 births. High birth weight and maternal pregestational DM associated nominally with CKD, with respective crude odds ratios (ORs) of 1.17 (95% confidence interval [95% CI], 1.03 to 1.34) and 1.97 (95% CI, 1.15 to 3.37); however, adjustment for maternal confounders attenuated these associations to 0.97 (95% CI, 0.79 to 1.21) and 1.19 (95% CI, 0.51 to 2.81), respectively. The adjusted ORs for CKD associated with other prenatal factors were 2.88 (95% CI, 2.28 to 3.63) for low birth weight, 1.54 (95% CI, 1.13 to 2.09) for maternal gestational DM, 1.24 (95% CI, 1.05 to 1.48) for maternal overweight, and 1.26 (95% CI, 1.05 to 1.52) for maternal obesity. In subgroup analysis by CKD subtype, low birth weight and maternal pregestational DM associated significantly with increased risk of renal dysplasia/aplasia. Low birth weight, maternal gestational DM, and maternal overweight/obesity associated significantly with obstructive uropathy. These data suggest that prenatal factors may impact the risk of CKD. Future studies should aim to determine if modification of these factors could reduce the risk of childhood CKD.
慢性肾脏病（CKD）的发生可能在产前就已编程。我们试图确定儿童CKD与产前危险因素之间的关联，这些因素包括出生体重、母亲糖尿病（DM）以及母亲超重/肥胖。我们在华盛顿州开展了一项基于人群的病例对照研究，研究对象包括1994例儿童CKD患者（诊断时年龄<21岁）和20,032名对照。我们将1987年至2008年出生记录中的母亲和婴儿特征与医院出院数据相联系，并使用逻辑回归分析来评估产前危险因素与儿童CKD之间的关联。CKD的患病率为每100,000例出生中有126.7例。高出生体重和母亲孕前DM与CKD名义上相关，其各自的粗比值比（OR）分别为1.17（95%置信区间[95%CI]，1.03至1.34）和1.97（95%CI，1.15至3.37）；然而，对母亲混杂因素进行调整后，这些关联分别减弱至0.97（95%CI，）和1.19（95%CI，0.51至2.81）。与其他产前因素相关的CKD调整后OR分别为：低出生体重2.88（95%CI，2.28至3.63），母亲妊娠期DM 1.54（95%CI，1.13至2.09），母亲超重1.24（95%CI，1.05至1.48），母亲肥胖1.26（95%CI，1.05至1.52）。在按CKD亚型进行的亚组分析中，低出生体重和母亲孕前DM与肾发育异常/发育不全风险增加显著相关。低出生体重、母亲妊娠期DM以及母亲超重/肥胖与梗阻性尿路病显著相关。这些数据表明产前因素可能影响CKD风险。未来的研究应旨在确定对这些因素进行干预是否可以降低儿童CKD的风险。
