Renal function and blood pressure are altered in adolescents born preterm

Pediatr Nephrol. 2019 Jan;34(1):137-144. doi: 10.1007/s00467-018-4050-z. Epub 2018 Aug 15.

Abstract

Background: Preterm birth increases the risk of hypertension and kidney disease. However, it is unclear when changes in blood pressure (BP) and renal function become apparent and what role obesity and sex play. We hypothesized adolescents born preterm have higher BP and worse kidney function compared to term in an obesity- and sex-dependent manner.

Methods: Cross-sectional analysis of 14-year-olds born preterm with very low birth weight (n = 96) compared to term (n = 43). We used generalized linear models to estimate the associations among preterm birth and BP, estimated glomerular filtration rate (eGFR), and ln (x) urinary albumin-to-creatinine ratio (ACR), stratified by overweight/obesity (OWO, body mass index (BMI) ≥ 85th percentile) and sex.

Results: Compared to term, preterm-born adolescents had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) (adjusted β (aβ) 3.5 mmHg, 95% CI - 0.1 to 7.2 and 3.6 mmHg, 95% CI 0.1 to 7.0), lower eGFR (β - 8.2 mL/min/1.73 m2, 95% CI - 15.9 to - 0.4), and higher ACR (aβ 0.34, 95% CI - 0.04 to 0.72). OWO modified the preterm-term difference in DBP (BMI < 85th percentile aβ 5.0 mmHg, 95% CI 0.7 to 9.2 vs. OWO 0.2 mmHg, 95% CI - 5.3 to 5.6) and ACR (OWO aβ 0.72, 95% CI 0.15 to 1.29 vs. BMI < 85th percentile 0.17, 95% CI - 0.31 to 0.65). Sex modified the preterm-term ACR difference (female aβ 0.52, 95% CI 0.001 to 1.04 vs. male 0.18, 95% CI - 0.36 to 0.72).

Conclusions: Prematurity was associated with higher BP and reduced renal function that were detectable in adolescence. OWO and sex may modify the strength of these relationships.

Keywords: Chronic kidney disease; Hypertension; Obesity; Programming; Sex differences; Very low birth weight.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Pressure / physiology
  • Body Mass Index
  • Creatinine / blood
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology
  • Humans
  • Hypertension / blood
  • Hypertension / epidemiology
  • Hypertension / physiopathology*
  • Infant, Newborn
  • Infant, Very Low Birth Weight / physiology
  • Kidney / physiopathology*
  • Male
  • Overweight / epidemiology*
  • Overweight / physiopathology
  • Pregnancy
  • Premature Birth / physiopathology*
  • Prenatal Exposure Delayed Effects / blood
  • Prenatal Exposure Delayed Effects / epidemiology
  • Prenatal Exposure Delayed Effects / physiopathology*
  • Risk Factors
  • Serum Albumin, Human / analysis
  • Sex Factors

Substances

  • Creatinine
  • Serum Albumin, Human