咖啡因对极低出生体重儿 2 年时肾功能的影响。
Caffeine and kidney function at two years in former extremely low gestational age neonates.
机构信息
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Pediatr Res. 2024 Jan;95(1):257-266. doi: 10.1038/s41390-023-02792-y. Epub 2023 Sep 2.
BACKGROUND
Extremely low gestational age neonates (ELGANs) are at risk for chronic kidney disease. The long-term kidney effects of neonatal caffeine are unknown. We hypothesize that prolonged caffeine exposure will improve kidney function at 22-26 months.
METHODS
Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates <28 weeks' gestation. Participants included if any kidney outcomes were collected at 22-26 months corrected age. Exposure was post-menstrual age of caffeine discontinuation.
PRIMARY OUTCOMES
'reduced eGFR' <90 ml/min/1.73 m, 'albuminuria' (>30 mg albumin/g creatinine), or 'elevated blood pressure' (BP) >95th %tile. A general estimating equation logistic regression model stratified by bronchopulmonary dysplasia (BPD) status was used.
RESULTS
598 participants had at least one kidney metric at follow up. Within the whole cohort, postmenstrual age of caffeine discontinuation was not associated with any abnormal measures of kidney function at 2 years. In the stratified analysis, for each additional week of caffeine, the no BPD group had a 21% decreased adjusted odds of eGFR <90 ml/min/1.73m (aOR 0.78; CI 0.62-0.99) and the BPD group had a 15% increased adjusted odds of elevated BP (aOR 1.15; CI: 1.05-1.25).
CONCLUSIONS
Longer caffeine exposure during the neonatal period is associated with differential kidney outcomes at 22-26 months dependent on BPD status.
IMPACT
In participants born <28 weeks' gestation, discontinuation of caffeine at a later post menstrual age was not associated with abnormal kidney outcomes at 22-26 months corrected age. When assessed at 2 years of age, later discontinuation of caffeine in children born <28 weeks' gestation was associated with a greater risk of reduced eGFR in those without a history of BPD and an increased odds of hypertension in those with a history of BPD. More work is necessary to understand the long-term impact of caffeine on the developing kidney.
背景
极低胎龄新生儿（ELGANs）有发生慢性肾脏病的风险。新生儿咖啡因的长期肾脏影响尚不清楚。我们假设延长咖啡因暴露时间将改善 22-26 个月时的肾功能。
方法
对胎龄<28 周的早产儿促红细胞生成素神经保护试验的二次分析。如果在 22-26 个月的校正年龄时收集了任何肾脏结局，则将其纳入研究。暴露于咖啡因停药时的校正胎龄。
主要结局
“降低的 eGFR”<90ml/min/1.73m、“蛋白尿”（>30mg 白蛋白/g 肌酐）或“血压升高”（BP）>95%分位数。使用按支气管肺发育不良（BPD）状态分层的一般估计方程逻辑回归模型。
结果
598 名参与者在随访时有至少一项肾脏指标。在整个队列中，咖啡因停药时的校正胎龄与 2 岁时任何异常肾功能指标均无关。在分层分析中，对于每增加一周的咖啡因，无 BPD 组降低调整后 eGFR<90ml/min/1.73m 的调整比值比（aOR 0.78；CI 0.62-0.99）的风险降低 21%，BPD 组血压升高的调整比值比（aOR 1.15；CI：1.05-1.25）增加 15%。
结论
新生儿期较长的咖啡因暴露与 BPD 状态相关的 22-26 个月时的肾脏结局不同。
影响
在胎龄<28 周的参与者中，在较晚的校正胎龄时停止使用咖啡因与 22-26 个月校正年龄时的异常肾脏结局无关。在 2 岁时评估时，在没有 BPD 病史的儿童中，较晚停止使用咖啡因与 eGFR 降低的风险增加相关，而在有 BPD 病史的儿童中，高血压的几率增加。需要更多的工作来了解咖啡因对发育中肾脏的长期影响。
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