High Prevalence and Limited Perinatal Prediction of Kidney Dysfunction in Adolescents Born Extremely Preterm.
10 affiliations
- 1Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA.
- 2University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
- 3Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
- 4Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
- 5Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
- 6Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
- 7Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
- 8Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
- 9Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
- 10Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
Abstract
Introduction
Extremely preterm birth (< 28 weeks' gestation) increases chronic kidney disease (CKD) risk. However, among those born extremely preterm, the prevalence of abnormal kidney health during adolescence and its perinatal predictors remain poorly defined.Methods
Adolescents from the Extremely Low Gestational Age Newborn -Environmental influences on Child Health Outcomes (ELGAN-ECHO) cohort (14 US hospitals) were assessed for abnormal kidney health defined as ≥ 1 indicator-chronic kidney disease in children (CKiD) U25 estimated glomerular filtration rate (eGFR) < 90 ml/min per 1.73 m², blood pressure (BP) ≥ 120/80 mm Hg, or microalbuminuria > 30 mg/g.Five feature selection methods screened perinatal covariate predictors using a 60 to 40 training-test split. Multiple imputation addressed missing data in sensitivity analyses. Area under the curve (AUC) was the primary performance metric.Results
Of the 675 adolescents (mean age 18 years), 354 (52%) had a classifiable kidney health status, as follows: 188 with all 3 measurements and 166 with partial measurements showing ≥ 1 abnormality. The prevalence of abnormal kidney health was 66% among complete cases (125/188) and 82% among all determinate cases (291/354). In the full cohort, prevalence ranged from 43% to 91% (bounding estimates accounting for missing data). Individual measurements revealed 30.5% with reduced eGFR, 42% with elevated BP, and 9% with microalbuminuria. Across all methods, perinatal covariates achieved random test-set discrimination (AUC: 0.48-0.55) for abnormal kidney health prediction, compared with training set AUCs of 0.66-0.72.Conclusion
Abnormal kidney health is highly prevalent after extremely preterm birth, underscoring the importance of protocolized longitudinal kidney health surveillance throughout childhood to enable early identification of CKD and elevated BP in children born extremely preterm. The perinatal factors we examined did not meaningfully predict kidney health abnormalities and variable importance did not translate to individual-level prediction in this cohort.
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BibTeX
@article{sanderson2026high,
title = {{High Prevalence and Limited Perinatal Prediction of Kidney Dysfunction in Adolescents Born Extremely Preterm.}},
author = {Keia R Sanderson and Jesus E Vazquez and Jennifer E Flythe and David Askenazi and Michael R Kosorok and Minxin Lu and Kartikeya Makker and Matthew Laughon and Christine E Kistler and Rebecca C Fry and Thomas Michael O'Shea},
journal = {Kidney international reports},
year = {2026},
month = sep,
doi = {10.1016/j.ekir.2026.107086},
url = {https://europepmc.org/article/MED/42903614},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - High Prevalence and Limited Perinatal Prediction of Kidney Dysfunction in Adolescents Born Extremely Preterm.
AU - Keia R Sanderson
AU - Jesus E Vazquez
AU - Jennifer E Flythe
AU - David Askenazi
AU - Michael R Kosorok
AU - Minxin Lu
AU - Kartikeya Makker
AU - Matthew Laughon
AU - Christine E Kistler
AU - Rebecca C Fry
AU - Thomas Michael O'Shea
PY - 2026
DA - 2026/09/17
JO - Kidney international reports
DO - 10.1016/j.ekir.2026.107086
UR - https://europepmc.org/article/MED/42903614
AB - Introduction Extremely preterm birth (< 28 weeks' gestation) increases chronic kidney disease (CKD) risk. However, among those born extremely preterm, the prevalence of abnormal kidney health during adolescence and its perinatal predictors remain poorly defined.Methods Adolescents from the Extremely Low Gestational Age Newborn -Environmental influences on Child Health Outcomes (ELGAN-ECHO) cohort (14 US hospitals) were assessed for abnormal kidney health defined as ≥ 1 indicator-chronic kidney disease in children (CKiD) U25 estimated glomerular filtration rate (eGFR) < 90 ml/min per 1.73 m², blood pressure (BP) ≥ 120/80 mm Hg, or microalbuminuria > 30 mg/g.Five feature selection methods screened perinatal covariate predictors using a 60 to 40 training-test split. Multiple imputation addressed missing data in sensitivity analyses. Area under the curve (AUC) was the primary performance metric.Results Of the 675 adolescents (mean age 18 years), 354 (52%) had a classifiable kidney health status, as follows: 188 with all 3 measurements and 166 with partial measurements showing ≥ 1 abnormality. The prevalence of abnormal kidney health was 66% among complete cases (125/188) and 82% among all determinate cases (291/354). In the full cohort, prevalence ranged from 43% to 91% (bounding estimates accounting for missing data). Individual measurements revealed 30.5% with reduced eGFR, 42% with elevated BP, and 9% with microalbuminuria. Across all methods, perinatal covariates achieved random test-set discrimination (AUC: 0.48-0.55) for abnormal kidney health prediction, compared with training set AUCs of 0.66-0.72.Conclusion Abnormal kidney health is highly prevalent after extremely preterm birth, underscoring the importance of protocolized longitudinal kidney health surveillance throughout childhood to enable early identification of CKD and elevated BP in children born extremely preterm. The perinatal factors we examined did not meaningfully predict kidney health abnormalities and variable importance did not translate to individual-level prediction in this cohort.
SN - 2468-0249
ER -