ESPN 53rd Annual Meeting

ESPN 2021


 
MODELLING OF RENAL FUNCTION IN FORMER EXTREMELY LOW BIRTHWEIGHT INFANTS IN LATE CHILDHOOD
Marieke Colleman 1 Elena Levtchenko 1 Zhenyu Zhang 2 Jan A. Staessen 3 Jan A. Staessen 4 Karel Allegaert 1 Karel Allegaert 6 Karel Allegaert 5 Anke Raaijmakers 7

1- Department of Development and Regeneration, Katholieke Universiteit Leuven, Belgium
2- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium
3- Biomedical Science Group, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium
4- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
5- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Belgium
6- Department of Clinical Pharmacy, Erasmus MC, Rotterdam, The Netherlands
7- Department of Pediatrics, campus Jan Palfijn, ZNA hospitals, Antwerp, Belgium
 
Abstract:

Objectives

Extremely low birthweight (ELBW) infants suffer from poorer outcomes in later life, including lower estimated glomerular filtration rate (eGFR). We aim to identify the perinatal factors influencing these outcomes, as previously reported for neurodevelopmental outcome, enabling targeted renal follow-up.

Methods

As part of the PREMATCH study, we evaluated and compared eGFR in 59 ELBW children and 71 controls at age 11. Adverse renal outcome was defined as presence of chronic kidney disease (CKD) stage 2 (eGFR <90 ml/1.73m2/min). We investigated perinatal factors associated with this adverse renal outcome to develop a proof-of-concept model to predict the proportional risk of CKD stage 2 in ELBW children.

Results

We confirmed that ELBW children suffer from lower average eGFR than controls (94.1 vs. 106.5 ml/1.73m2/min, p<0.001). Amongst ELBW children 34.5% progressed to CKD stage 2. ELBW children with CKD stage 2 were more frequently male (75% vs. 47.7%, p=0.055), were ventilated significantly longer post-birth (17 vs. 9 days, p=0.006) and suffered more commonly from intraventricular hemorrhage (IVH) (40% vs. 15.8%, p=0.056). In contrast, birthweight, gestational age, steroids/ibuprofen use, duration of oxygen therapy, retinopathy of prematurity and bronchopulmonary dysplasia showed no significant association to renal function in adolescence. In our model, we developed a score (0-3) to determine the risk of CKD stage 2 based on the cumulative perinatal risk factors sex (male), ventilation duration (>10 days), and IVH. We found this risk to increase linearly from 0% to 80%, delineated as follows - 0 points: 0%; 1 point: 25%; 2 points: 47%; and 3 points: 80%.

Conclusions

ELBW children have poorer renal function and are at increased risk to develop CKD stage 2 by age 11. Renal function in ELBW children is influenced by identifiable perinatal factors, which can be scored to predict the occurrence of CKD stage 2, facilitating targeted follow-up.