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Abstract: TH-PO580

Association of Preterm Birth with Adverse Outcomes of Glomerular Disease in Children and Adults in the CureGN Cohort

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Isaac, Jaya, Children's Hospital at Montefiore, New York, New York, United States
  • Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States
  • Wang, Yujie, University of Michigan, Ann Arbor, Michigan, United States
  • Garrity, Kelly, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Kaskel, Rick, Children's Hospital at Montefiore, New York, New York, United States
  • Gbadegesin, Rasheed A., Duke University, Durham, North Carolina, United States
  • Reidy, Kimberly J., Children's Hospital at Montefiore, New York, New York, United States
Background

While some studies of children with nephrotic syndrome have demonstrated worse outcomes in those born preterm vs. term, there is little data on associations of preterm birth with kidney and cardiovascular outcomes in adult-onset glomerular disease.

Methods

We performed a cross-sectional and longitudinal survival analysis of participants in the Cure Glomerulonephropathy (CureGN) cohort with birth history data. Preterm (<37 weeks gestation) was compared to term (≥37 weeks gestation). Baseline characteristics and cardiovascular outcomes were compared using Chi-square and Mann Whitney testing. A survival analysis and adjusted Cox proportional hazards model was used to examine a composite outcome of 40% decline in estimated glomerular filtration rate (eGFR) or progression to End Stage Kidney Disease (ESKD). An adjusted logistic regression model was used to examine remission of proteinuria.

Results

More pediatric than adult participants in CureGN were born preterm: 12.8% (118/919) vs. 7.69% (117/1521) (p<0.001). Adults born preterm had a higher prevalence of Focal Segmental Glomerulosclerosis (FSGS) (35% vs. 25%, p=0.01) and APOL1 high risk genotype (9.4% vs 4.2%, p=0.01) as compared to adults born term. Pediatric participants born preterm were more likely to have hypertension at enrollment (p=0.001). While there was no difference in eGFR at enrollment, participants born preterm had a shorter time interval to a 40% eGFR decline/developing ESKD after biopsy (p=0.001). In adjusted analysis, preterm participants were 28% more likely to develop 40% eGFR decline/ESKD (p=0.008) and 38% less likely to attain complete remission of proteinuria (p=0.006). There was no statistically significant difference in ever having hypertension or other cardiovascular events between the two groups.

Conclusion

Preterm birth was a risk factor for adverse outcomes in this heterogenous cohort of children and adults with glomerular disease. Children born preterm were more likely to have baseline hypertension while adults born preterm were more likely to have an APOL1 high risk genotype and FSGS. Even in analyses adjusted for FSGS and APOL1 risk status, there was a faster progression of chronic kidney disease in those born preterm. Low nephron endowment and other perinatal exposures may account for these differences.

Funding

  • NIDDK Support