title: Prenatal risk factors for childhood CKD.
abstract: Development of CKD may be programmed prenatally. We sought to determine the association of childhood CKD with prenatal risk factors, including birth weight, maternal diabetes mellitus (DM), and maternal overweight/obesity. We conducted a population-based, case-control study with 1994 patients with childhood CKD (<21 years of age at diagnosis) and 20,032 controls in Washington state. We linked maternal and infant characteristics in birth records from 1987 to 2008 to hospital discharge data and used logistic regression analysis to assess the association of prenatal risk factors with childhood CKD. The prevalence of CKD was 126.7 cases per 100,000 births. High birth weight and maternal pregestational DM associated nominally with CKD, with respective crude odds ratios (ORs) of 1.17 (95% confidence interval [95% CI], 1.03 to 1.34) and 1.97 (95% CI, 1.15 to 3.37); however, adjustment for maternal confounders attenuated these associations to 0.97 (95% CI, 0.79 to 1.21) and 1.19 (95% CI, 0.51 to 2.81), respectively. The adjusted ORs for CKD associated with other prenatal factors were 2.88 (95% CI, 2.28 to 3.63) for low birth weight, 1.54 (95% CI, 1.13 to 2.09) for maternal gestational DM, 1.24 (95% CI, 1.05 to 1.48) for maternal overweight, and 1.26 (95% CI, 1.05 to 1.52) for maternal obesity. In subgroup analysis by CKD subtype, low birth weight and maternal pregestational DM associated significantly with increased risk of renal dysplasia/aplasia. Low birth weight, maternal gestational DM, and maternal overweight/obesity associated significantly with obstructive uropathy. These data suggest that prenatal factors may impact the risk of CKD. Future studies should aim to determine if modification of these factors could reduce the risk of childhood CKD.
authors.affiliation: Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Division of Nephrology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington; cwhsu8@uw.edu.
authors.forename: Christine W
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Medicine, University of Hawaii, Honolulu, Hawaii;
authors.forename: Kalani T
authors.initials: KT
authors.lastname: Yamamoto
authors.affiliation: Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Rohan K
authors.initials: RK
authors.lastname: Henry
authors.affiliation: Department of Environmental and Occupational Health, School of Public Health, Drexel University, Philadelphia, Pennsylvania.
authors.forename: Anneclaire J
authors.initials: AJ
authors.lastname: De Roos
authors.affiliation: Division of Nephrology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington;
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Flynn
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D050177:Overweight / Q000150:complications; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D011297:Prenatal Exposure Delayed Effects / Q000209:etiology*; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: CKD; children; clinical epidemiology; intrauterine growth; obstructive uropathy; renal development
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