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Sunday, May 21, 2000

Study Relates Low Birthweight to Chronic Renal Failure

CHARLESTON, S.C. -- A relationship has been found between low birthweight and chronic renal failure according to a study published in the May 22 issue of the Archives of Internal Medicine and conducted by a team headed by Daniel Lackland, Dr.P.H., a Medical University of South Carolina (MUSC) epidemiologist.

Low birthweight is more common in South Carolina and in the Southeast, compared to other states and regions and is more common among blacks compared to whites. Therefore, the results of this study may provide an explanation for the high rates of renal failure in the southeastern region of the United States and among the black population.

The published study is entitled, “Low Birthweights Contribute to the High Rates of Early Onset Chronic Renal Failure in the Southeast United States.” Other investigators who participated in this study are Brent M. Egan, M.D., of the MUSC Department of Pharmacology and Holly E. Bendall, MSc, Clive Osmond, Ph.D., and David J.P. Barker, M.D., Ph.D., all of the Medical Research Council, Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England.

Lackland and his team identified 2,446 South Carolina residents who developed chronic renal failure before their 50th birthday and became dependent on renal dialysis. Of these, the investigators were able to obtain birthweight information on 1,230. They found that among people whose birthweight was less than 2.5 kilograms (approximately 5.5 pounds), the odds ratio for chronic renal failure was 1.4 compared with people who weighed between 3 and 3.5 kg (6.6 to 7.7 lbs.) at birth. This means that those with the lower birthweight were 1.4 times as likely to suffer from chronic renal failure than those of higher birthweights, explained Lackland, who is a professor of biometry and epidemiology at MUSC.  This led us to the conclusion that low birthweights, which reflect adverse effects on more development in utero, contribute to early onset of chronic renal failure.

The investigators also looked at the relationship between low birthweight and chronic renal failure resulting from a variety of causes, the most common being diabetes and hypertension.  They found that the association was present no matter what the underlying cause of the renal failure. This suggests that an adverse environment in  utero impairs kidney development and makes it more vulnerable to damage from a range of diseases, said Lackland.

The study has an important implication for public health policy, according to Lackland. He said that the number of people with chronic renal disease being maintained on dialysis is expected to increase during the next 40 years. This means that the economic burden to Medicare, which covers the costs of care will continue to grow with an increasing disease rate and an aging population.