The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Abstract

Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.

Keywords: Infant and child nutrition; Intrauterine growth restriction; Low birth weight; Maternal nutrition; Neonatal acute kidney injury; Nephron number; Preterm birth; Programmed risk of hypertension; Programmed risk of kidney disease; Small for gestational age.

Fig. 1

Number of infants born small for gestational age (SGA) or with low birth weight (LBW), and premature birth in low- and middle-income countries − 2010 (reprinted with permission according to CC Creative Commons Attribution-NonCommercial-noDerivs from Lee et al. [28]). A large number of infants born at term and SGA do not meet the definition of LBW and, therefore, likely experienced programming but may not be identified as at risk.

Fig. 2

Prevalence of SGA, preterm birth, and LBW infants by United Nations Millennium Development Goal regions in 2010 (reprinted with permissionaccording to CC Creative Commons Attribution-NonCommercial-noDerivs from Lee et al. [28]).

Fig. 3

Multi-hit nature of renal disease programming (reprinted with permission from Luyckx et al. [65]).

Fig. 4

Different packages of preconception care interventions (reprinted with permission according to CC Creative Commons Attribution-NonCommercial-noDerivs from Lassi et al. [266]).