Effects of prematurity on long-term renal health: a systematic review

OBJECTIVE: To investigate the literature and determine if prematurity has an impact on long-term adverse kidney outcomes. DESIGN: Systematic review. DATA SOURCES: OVID Medline, PubMed, SCOPUS, CINAHL and EMBASE databases were searched for studies relating to the adverse outcomes of prematurity from 1990 to April 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All articles published between January 1990 and April 2021 that investigated whether premature infants developed long-term adverse renal outcomes were included in this review. Articles must have been human studies and written in English. Case series with less than 20 participants and case studies were excluded. DATA EXTRACTION AND SYNTHESIS: One reviewer completed the database searches. Article selection was performed independently and in a non-blinded manner by both reviewers. Initial screening was by title and abstract. Full texts of remaining articles were reviewed. Articles for which inclusion was unclear were re-reviewed by both reviewers, and a unanimous decision was taken as to whether they should be included. The Newcastle–Ottawa Scale was used for quality assessment of the included articles. RESULTS: The literature search yielded 31 human studies, which investigated the short-term and long-term kidney outcomes of prematurity. These studies were conducted in 17 different countries. The most common outcomes measured were blood pressure (BP) and glomerular filtration rate. Other common outcomes measured included kidney size and mass, proteinuria, albuminuria, chronic kidney disease (CKD) and physical parameters such as height, weight and body mass index. CONCLUSION: Prematurity is likely linked to increased risk of kidney dysfunction and high BP in childhood and into early adulthood. Premature birth conferred a twofold increased risk of CKD and extremely premature birth conferred a threefold increased risk of CKD. However, further larger multicentre studies are needed to draw definitive conclusions on the long-term kidney outcomes of prematurity.