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Renal function and blood pressure are altered in adolescents born preterm

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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.

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Acknowledgements

We would like to thank the participants and their families, Patricia Brown, RN, research nurse, and Alice Scott, RN, research study coordinator. Patricia Brown and Alice Scott have no conflicts of interest.

Funding

This study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01 HD047584; HD084227), the American Heart Association (AHA 14GRNT20480131), the Clinical Research Unit of Wake Forest Baptist Medical Center (MCRR/NIH M01-RR07122), the Wake Forest Clinical and Translational Science Award (NIH UL1 TR001420), and Forsyth Medical Center and Wake Forest School of Medicine Department of Pediatrics research funds.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Andrew M. South, Patricia A. Nixon & Lisa K. Washburn

  2. Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Andrew M. South, Mark C. Chappell, Debra I. Diz, Hossam A. Shaltout & Lisa K. Washburn

  3. Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Andrew M. South & Elizabeth T. Jensen

  4. Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA

    Patricia A. Nixon

  5. Department of Surgery-Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Mark C. Chappell & Debra I. Diz

  6. Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Gregory B. Russell

  7. Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Hossam A. Shaltout

  8. Department of Pharmacology and Toxicology, School of Pharmacy, University of Alexandria, Alexandria, Egypt

    Hossam A. Shaltout

  9. Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    T. Michael O’Shea

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  1. Andrew M. South
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  9. Lisa K. Washburn
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Corresponding author

Correspondence to Andrew M. South.

Ethics declarations

The Wake Forest School of Medicine and Forsyth Medical Center Institutional Review Boards approved the study. Parents or legal guardians provided written informed consent, and participants provided assent.

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The authors declare that they have no conflict of interest.

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South, A.M., Nixon, P.A., Chappell, M.C. et al. Renal function and blood pressure are altered in adolescents born preterm. Pediatr Nephrol 34, 137–144 (2019). https://doi.org/10.1007/s00467-018-4050-z

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  • DOI: https://doi.org/10.1007/s00467-018-4050-z

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