儿童期肾脏疾病史与成人终末期肾脏疾病风险。

History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease.

机构信息

From Hadassah-Hebrew University Braun School of Public Health (R.C.-M.) and the Director's Office, Israel Ministry of Health (A.A.), Jerusalem, the Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, and the Israel Renal Registry, Tel Aviv (E.G.), the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (E.G., A.L., A.A., A.V.), the Israel Defense Forces Medical Corps, Tel HaShomer (G.T., A.L., D.T., A.V.), Talpiot Medical Leadership Program (G.T., A.V.), Chaim Sheba Medical Center Management (A.A.), and Pediatric Department B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital (A.V.), Chaim Sheba Medical Center, Tel Hashomer, the Institute of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ashdod, and the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva (A.L.), and the Department of Nephrology, Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa (K.S.) - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge (A.L.), and the Division of Nephrology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston (A.V.) - both in Massachusetts.

出版信息

N Engl J Med. 2018 Feb 1;378(5):428-438. doi: 10.1056/NEJMoa1700993.

DOI:10.1056/NEJMoa1700993

PMID:29385364

Abstract

BACKGROUND

The long-term risk associated with childhood kidney disease that had not progressed to chronic kidney disease in childhood is unclear. We aimed to estimate the risk of future end-stage renal disease (ESRD) among adolescents who had normal renal function and a history of childhood kidney disease.

METHODS

We conducted a nationwide, population-based, historical cohort study of 1,521,501 Israeli adolescents who were examined before compulsory military service in 1967 through 1997; data were linked to the Israeli ESRD registry. Kidney diseases in childhood included congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease; all participants included in the primary analysis had normal renal function and no hypertension in adolescence. Cox proportional-hazards models were used to estimate the hazard ratio for ESRD associated with a history of childhood kidney disease.

RESULTS

During 30 years of follow-up, ESRD developed in 2490 persons. A history of any childhood kidney disease was associated with a hazard ratio for ESRD of 4.19 (95% confidence interval [CI], 3.52 to 4.99). The associations between each diagnosis of kidney disease in childhood (congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease) and the risk of ESRD in adulthood were similar in magnitude (multivariable-adjusted hazard ratios of 5.19 [95% CI, 3.41 to 7.90], 4.03 [95% CI, 3.16 to 5.14], and 3.85 [95% CI, 2.77 to 5.36], respectively). A history of kidney disease in childhood was associated with younger age at the onset of ESRD (hazard ratio for ESRD among adults <40 years of age, 10.40 [95% CI, 7.96 to 13.59]).

CONCLUSIONS

A history of clinically evident kidney disease in childhood, even if renal function was apparently normal in adolescence, was associated with a significantly increased risk of ESRD, which suggests that kidney injury or structural abnormality in childhood has long-term consequences.

摘要

背景

儿童期未进展为慢性肾脏病的肾脏疾病的长期风险尚不清楚。我们旨在评估曾患有儿童期肾脏疾病但肾功能正常的青少年未来发生终末期肾病（ESRD）的风险。

方法

我们进行了一项全国性、基于人群的历史队列研究，纳入了 1521501 名在 1967 年至 1997 年期间接受兵役前体检的以色列青少年；数据与以色列 ESRD 登记处相关联。儿童期的肾脏疾病包括肾脏和泌尿道先天畸形、肾盂肾炎和肾小球疾病；所有纳入主要分析的参与者在青少年时期均肾功能正常且无高血压。使用 Cox 比例风险模型估计与儿童期肾脏疾病史相关的 ESRD 风险比。

结果

在 30 年的随访期间，有 2490 人发生了 ESRD。曾患有任何儿童期肾脏疾病与 ESRD 的风险比为 4.19（95%置信区间[CI]，3.52 至 4.99）。儿童期每种肾脏疾病（肾脏和泌尿道先天畸形、肾盂肾炎和肾小球疾病）的诊断与成年后 ESRD 风险之间的关联在程度上相似（多变量调整后的风险比分别为 5.19[95%CI，3.41 至 7.90]、4.03[95%CI，3.16 至 5.14]和 3.85[95%CI，2.77 至 5.36]）。儿童期肾脏疾病史与 ESRD 发病年龄较早相关（40 岁以下成年人发生 ESRD 的风险比为 10.40[95%CI，7.96 至 13.59]）。