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White SL, Perkovic V, Cass A, et al. Is low birth weight an antecedent of CKD in later life? A systematic review of observational studies. Am J Kidney Dis. 2009 Aug;54(2):248-61. Epub 2009 Apr 1. (Review) PMID: 19339091
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Clinical Evidence Topic: Chronic Renal Failure
DISCIPLINE	RELEVANCE TO PRACTICE	IS THIS NEWS?
Nephrology
Pediatric Neonatology
Pediatrics (General)

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Abstract
BACKGROUND: There has been considerable interest in the hypothesis that low birth weight may be a marker of impaired nephrogenesis and that this is causally related to chronic kidney disease (CKD). STUDY DESIGN: Systematic review and meta-analysis of observational studies. SETTING & POPULATION: Studies of the relationship between birth weight and CKD published before February 1, 2008, were identified by using electronic searches. SELECTION CRITERIA: All studies that had collected data for birth weight and kidney function at greater than 12 months of age were eligible for inclusion, except for studies of extremely low-birth-weight infants, very premature infants, or toxic exposure in utero. STUDY FACTOR: Birth weight. OUTCOMES: CKD defined as albuminuria, low estimated glomerular filtration rate (<60 mL/min/1.73 m(2) or < 10th centile for age/sex), or end-stage renal disease. RESULTS: We analyzed 31 relevant cohort or case-control studies with data for 49,376 individuals and data for 2,183,317 individuals from a single record-linkage study. Overall, 16 studies reported a significant association between low birth weight and risk of CKD and 16 observed a null result. The combination of weighted estimates from the 18 studies for which risk estimates were available (n = 46,249 plus 2,183,317 from the record linkage study) gave an overall odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.44 to 2.08). Combined ORs were consistent in magnitude and direction for risks of albuminuria (OR, 1.81; 95% CI, 1.19 to 2.77), end-stage renal disease (OR, 1.58; 95% CI, 1.33 to 1.88), or low estimated glomerular filtration rate (OR, 1.79; 95% CI, 1.31 to 2.45). LIMITATIONS: A reliance on published estimates and estimates provided on request rather than individual patient data and the possibility of reporting bias. CONCLUSIONS: Existing data indicate that low birth weight is associated with subsequent risk of CKD, although there is scope for additional well-designed population-based studies with accurate assessment of birth weight and kidney function and consideration of important confounders, including maternal and socioeconomic factors.

Abstract

BACKGROUND: There has been considerable interest in the hypothesis that low birth weight may be a marker of impaired nephrogenesis and that this is causally related to chronic kidney disease (CKD). STUDY DESIGN: Systematic review and meta-analysis of observational studies. SETTING & POPULATION: Studies of the relationship between birth weight and CKD published before February 1, 2008, were identified by using electronic searches. SELECTION CRITERIA: All studies that had collected data for birth weight and kidney function at greater than 12 months of age were eligible for inclusion, except for studies of extremely low-birth-weight infants, very premature infants, or toxic exposure in utero. STUDY FACTOR: Birth weight. OUTCOMES: CKD defined as albuminuria, low estimated glomerular filtration rate (<60 mL/min/1.73 m(2) or < 10th centile for age/sex), or end-stage renal disease.
RESULTS: We analyzed 31 relevant cohort or case-control studies with data for 49,376 individuals and data for 2,183,317 individuals from a single record-linkage study. Overall, 16 studies reported a significant association between low birth weight and risk of CKD and 16 observed a null result. The combination of weighted estimates from the 18 studies for which risk estimates were available (n = 46,249 plus 2,183,317 from the record linkage study) gave an overall odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.44 to 2.08). Combined ORs were consistent in magnitude and direction for risks of albuminuria (OR, 1.81; 95% CI, 1.19 to 2.77), end-stage renal disease (OR, 1.58; 95% CI, 1.33 to 1.88), or low estimated glomerular filtration rate (OR, 1.79; 95% CI, 1.31 to 2.45). LIMITATIONS: A reliance on published estimates and estimates provided on request rather than individual patient data and the possibility of reporting bias.
CONCLUSIONS: Existing data indicate that low birth weight is associated with subsequent risk of CKD, although there is scope for additional well-designed population-based studies with accurate assessment of birth weight and kidney function and consideration of important confounders, including maternal and socioeconomic factors.

Comments from Clinical Raters
Nephrology Confirmatory of previous general impressions but now shows the variety of mechanisms relating low birth rate to CKD. Of particular interest is the distinction between circumstances not necessarily confined to pregnancy that lead to low birth weight.
Pediatric Neonatology This systematic review evaluated the evidence for LBW as a determinant of subsequent chronic kidney disease (CKD) risk. It was interesting to note that sex difference (stronger association of CKD in LBW males) was non-significant in the meta-regression analysis. Also interesting was the significant association in twins, lending credibility to the hypothesis. In Tables 1 and 2 outlining the characteristics of the studies analysed, nearly half of them had studied at-risk populations and several more had study subjects that were NOT representative of the general population. The discussion by the authors was excellent, outlining the limitations of this systematic review. However, paediatricians are left wondering `what can be done with this information?` While useful preventive measures such as improving nutrition in pregnant women can be implemented, even health care systems in developed countries will not be able to provide regular ``surveillance`` for CKD for the LBW baby.

Comments from Clinical Raters

Nephrology

Confirmatory of previous general impressions but now shows the variety of mechanisms relating low birth rate to CKD. Of particular interest is the distinction between circumstances not necessarily confined to pregnancy that lead to low birth weight.

Pediatric Neonatology

This systematic review evaluated the evidence for LBW as a determinant of subsequent chronic kidney disease (CKD) risk. It was interesting to note that sex difference (stronger association of CKD in LBW males) was non-significant in the meta-regression analysis. Also interesting was the significant association in twins, lending credibility to the hypothesis. In Tables 1 and 2 outlining the characteristics of the studies analysed, nearly half of them had studied at-risk populations and several more had study subjects that were NOT representative of the general population. The discussion by the authors was excellent, outlining the limitations of this systematic review. However, paediatricians are left wondering `what can be done with this information?` While useful preventive measures such as improving nutrition in pregnant women can be implemented, even health care systems in developed countries will not be able to provide regular ``surveillance`` for CKD for the LBW baby.

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