Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 1:365:l1346.
doi: 10.1136/bmj.l1346.

Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study

Casey Crump  1 , Jan Sundquist  2 , Marilyn A Winkleby  3 , Kristina Sundquist  2
Affiliations

Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study

Casey Crump et al. BMJ. .

Abstract

Objective: To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood.

Design: National cohort study.

Setting: Sweden.

Participants: 4 186 615 singleton live births in Sweden during 1973-2014.

Exposures: Gestational age at birth, identified from nationwide birth records in the Swedish birth registry.

Main outcome measures: CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors.

Results: 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.

Conclusions: Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Adjusted hazard ratios for chronic kidney disease (CKD) by gestational age at birth compared with full term birth, Sweden, 1973-2015
Fig 2
Fig 2
Adjusted hazard ratios for chronic kidney disease at ages 0-43 and 20-43 years by gestational age at birth compared with full term birth, Sweden, 1973-2015. Whiskers are 95% confidence intervals
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Faa G, Gerosa C, Fanni D, et al. Morphogenesis and molecular mechanisms involved in human kidney development. J Cell Physiol 2012;227:1257-68. 10.1002/jcp.22985. - DOI - PubMed
    1. Hinchliffe SA, Sargent PH, Howard CV, Chan YF, van Velzen D. Human intrauterine renal growth expressed in absolute number of glomeruli assessed by the disector method and Cavalieri principle. Lab Invest 1991;64:777-84. - PubMed
    1. Abitbol CL, Rodriguez MM. The long-term renal and cardiovascular consequences of prematurity. Nat Rev Nephrol 2012;8:265-74. 10.1038/nrneph.2012.38. - DOI - PubMed
    1. Abitbol CL, DeFreitas MJ, Strauss J. Assessment of kidney function in preterm infants: lifelong implications. Pediatr Nephrol 2016;31:2213-22. 10.1007/s00467-016-3320-x. - DOI - PubMed
    1. Keller G, Zimmer G, Mall G, Ritz E, Amann K. Nephron number in patients with primary hypertension. N Engl J Med 2003;348:101-8. 10.1056/NEJMoa020549. - DOI - PubMed

Publication types