Yen Fu-Shun, Wei James Cheng-Chung, Cheng Wan-Yin, Huang Chi-Ting, Wu Yi-Ling, Teh Suan-Heoh, Hwu Chii-Min, Hsu Chih-Cheng
Dr Yen's Clinic, Taoyuan, Taiwan.
Department of Nursing, Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
Nephrol Dial Transplant. 2025 Aug 1;40(8):1550-1558. doi: 10.1093/ndt/gfaf018.
It is unclear whether low birth weight (LBW), preterm birth and small for gestational age (SGA) could synergistically cause chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This cohort study was conducted to examine their individual and combined impacts on the development of CKD and ESKD in childhood.
From the Taiwan Maternal and Child Health Database, we identified 1 477 128 newborns born between 1 January 2009 and 31 December 2016. We used a multivariable Cox regression model to assess the excess risk of CKD and ESKD in children with LBW/preterm/SGA. They were followed from birth until the occurrence of outcomes or until 31 December 2018, with an average follow-up of 5.78 years.
This study included 1 361 071 infants with birth weight ≥2500 g (92.14%), 104 855 infants with low birth weight (1500 g to <2500 g) (7.10%), 6843 infants with very low birth weight (1000 g to <1500 g) (0.46%) and 4349 infants with extremely low birth weight (<1000 g) (0.29%). The multivariable-adjusted model showed that male infants with low birth weight were associated with an increased risk of CKD [adjusted hazard ratio (aHR) 1.20, 95% confidence interval (CI) 1.08-1.32] and ESKD (aHR 1.64, 95% CI 1.37-1.97). Female infants with LBW had an increased risk of CKD (aHR 1.18, 95% CI 1.06-1.32) and ESKD (aHR 1.31, 95% CI 1.09-1.58) than those without LBW. In addition to LBW, infants with preterm or SGA condition also had a significantly and synergistically increased risk of CKD and ESKD compared with full-term infants.
We found children with LBW, preterm birth or SGA had a significantly increased risk of CKD and ESKD compared with children without intrauterine growth restriction.
低出生体重（LBW）、早产和小于胎龄儿（SGA）是否会协同导致慢性肾脏病（CKD）和终末期肾病（ESKD）尚不清楚。本队列研究旨在探讨它们对儿童期CKD和ESKD发生发展的单独及综合影响。
从台湾妇幼健康数据库中，我们确定了1477128名在2009年1月1日至2016年12月31日期间出生的新生儿。我们使用多变量Cox回归模型评估低出生体重/早产/小于胎龄儿患CKD和ESKD的额外风险。从出生开始对他们进行随访，直至出现研究结局或至2018年12月31日，平均随访5.78年。
本研究纳入了1361071名出生体重≥2500g的婴儿（92.14%），104855名低出生体重（1500g至<2500g）的婴儿（7.10%），6843名极低出生体重（1000g至<1500g）的婴儿（0.46%）和4349名超低出生体重（<1000g）的婴儿（0.29%）。多变量调整模型显示，低出生体重男婴患CKD的风险增加[调整后风险比（aHR）1.20，95%置信区间（CI）1.08 - 1.32]，患ESKD的风险增加（aHR 1.64，95%CI 1.37 - 1.97）。与非低出生体重女婴相比，低出生体重女婴患CKD的风险增加（aHR 1.18，95%CI 1.06 - 1.32），患ESKD的风险增加（aHR 1.31，95%CI 1.09 - 1.58）。除低出生体重外，早产或小于胎龄儿的婴儿与足月儿相比，患CKD和ESKD的风险也显著且协同增加。
我们发现，与没有宫内生长受限的儿童相比，低出生体重、早产或小于胎龄儿的儿童患CKD和ESKD的风险显著增加。
