Extremely low gestational age neonates born <28 weeks gestation are at risk for chronic disease. We sought to describe the prevalence of kidney outcomes by gestational age and determine risk factors for their development.

The Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study examined kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo NeuroProtection Trial (PENUT) study. Kidney function, urine albumin, and BP were measured at 2-year (24±2 months) corrected gestational age. We compared outcomes across gestational age categories and evaluated associations between kidney-related outcomes and neonatal and maternal characteristics. The primary outcome was eGFR <90 ml/min per 1.73 m² (CKD); secondary outcomes were spot urine albumin-creatinine ratio ≥30 mg/g (albuminuria) and either systolic BP or diastolic BP >90th percentile for height, age, and sex.

A total of 832 survived to 2 years, and 565 (68%) had at least one outcome measured. Overall, 297 (53%) had one abnormal kidney outcome; 61 (18%) had an eGFR <90 ml/min per 1.73 m², 155 (36%) had albuminuria, 65 (22%) had elevated systolic BP, and 128 (44%) had elevated diastolic BP. Gestational age (odds ratio, 0.94; 95% confidence interval, 0.89 to 0.99), birth weight z-score (odds ratio, 0.92; 95% confidence interval, 0.85 to 0.98), and prenatal steroids (odds ratio, 1.23; 95% confidence interval, 1.08 to 1.39) were associated with an eGFR <90 ml/min per 1.73 m². An elevated systolic BP was associated with indomethacin use (odds ratio, 1.18; 95% confidence interval, 1.04 to 1.33) and Black race (odds ratio, 1.19; 95% confidence interval, 1.01 to 1.39); elevated diastolic BP was associated with male sex (odds ratio, 1.29; 95% confidence interval, 1.12 to 1.49), severe AKI (odds ratio, 1.24; 95% confidence interval, 1.04 to 1.48), and indomethacin use (odds ratio, 1.16; 95% confidence interval, 1.01 to 1.33).

Approximately 18% of extremely low gestational age neonates have CKD, 36% have albuminuria, 22% have an elevated systolic BP, and 44% have an elevated diastolic BP at 2 years of age. Gestational age, birthweight z-score, and prenatal steroids were associated with CKD. Male sex, Black race, indomethacin use, and severe AKI were associated with elevated BP.

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_07_19_CJN15011121.mp3

妊娠<28周出生的极低胎龄新生儿有患慢性病的风险。我们试图描述不同胎龄的肾脏结局的患病率，并确定其发展的危险因素。

用于保护婴儿肾病的重组促红细胞生成素 (REPAIRED) 研究检查了参加早产红细胞生成素神经保护试验 (PENUT) 研究的极低胎龄新生儿的肾脏结局。在2年（24±2个月）校正胎龄时测量肾功能、尿白蛋白和血压。我们比较了不同孕龄类别的结果，并评估了肾脏相关结果与新生儿和母亲特征之间的关联。主要结局为 eGFR <90 ml/min 每 1.73 m ² (CKD)；次要结局是尿白蛋白-肌酐比值≥30 mg/g（白蛋白尿），并且收缩压或舒张压>身高、年龄和性别的第90个百分位。

共有 832 人存活至 2 年，其中 565 人 (68%) 至少测量了一项结果。总体而言，297 人（53%）有一种肾脏结果异常；61 名 (18%) 的 eGFR <90 ml/min 每 1.73 m ²，155 名 (36%) 患有蛋白尿，65 名 (22%) 名收缩压升高，128 名 (44%) 名舒张压升高。胎龄（比值比，0.94；95% 置信区间，0.89 至 0.99）、出生体重z评分（比值比，0.92；95% 置信区间，0.85 至 0.98）和产前类固醇（比值比，1.23；95%）置信区间（1.08 至 1.39）与 eGFR <90 ml/min 每 1.73 m ²相关。收缩压升高与吲哚美辛的使用（比值比，1.18；95% 置信区间，1.04 至 1.33）和黑人种族（比值比，1.19；95% 置信区间，1.01 至 1.39）相关；舒张压升高与男性（比值比，1.29；95% 置信区间，1.12 至 1.49）、严重 AKI（比值比，1.24；95% 置信区间，1.04 至 1.48）和吲哚美辛使用（比​​值比，1.16）相关。 ；95% 置信区间，1.01 至 1.33）。

大约 18% 的极低胎龄新生儿患有 CKD，36% 患有蛋白尿，22% 患有收缩压升高，44% 患有 2 岁时舒张压升高。孕龄、出生体重z评分和产前类固醇与 CKD 相关。男性、黑人种族、吲哚美辛的使用和严重的 AKI 与血压升高相关。

本文包含播客 https://www.asn-online.org/media/podcast/CJASN/2022_07_19_CJN15011121.mp3