Fetal Growth Restriction and Acute Kidney Injury in Children and Young Adults.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42492855.
- Also identified by DOI 10.1016/j.kint.2026.06.037.
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Abstract
Fetal growth restriction is associated with reduced nephron endowment, suggesting increased kidney vulnerability across the life course. However, its association with acute kidney injury (AKI) beyond the neonatal period is not well defined. Individuals born with major birth defects may be particularly vulnerable due to impaired organ development and early-life comorbidities. Here, we examined whether fetal growth restriction, measured as birth weight for gestational age, is associated with the risk of AKI from infancy to early adulthood in individuals with and without major birth defects. In this nationwide, population-based cohort study, we included all individuals born alive in Denmark from August 1995 to February 2022. Data from national health registers and laboratory databases were linked using personal identifiers. Birth weight for gestational age was categorized as small (SGA, under 10<sup>th</sup> percentile), appropriate (AGA, 10-90<sup>th</sup> percentile), and large (LGA, over 90<sup>th</sup> percentile). AKI was defined biochemically based on plasma creatinine according to current consensus. Outcomes included 25-year risk of AKI and adjusted hazard ratios (aHRs) from Cox regression models, stratified by the presence of major birth defects. The cohort comprised 585,624 individuals without birth defects and 21,900 with birth defects. Among those without defects, the 25-year risk of AKI was 3.7% for SGA, 3.2% for AGA, and 3.1% for LGA. SGA was associated with higher AKI rates (aHR 1.20; 95% confidence interval, 1.13-1.27) compared to AGA. Among individuals with defects, risks were 15.2% for SGA, 9.9% for AGA, and 10.1% for LGA, with corresponding aHR 1.45 (95% confidence interval, 1.29-1.64) for SGA compared to AGA. Being born small for gestational age was associated with an increased risk of AKI from infancy to early adulthood, particularly among individuals with major birth defects. Greater clinical awareness may guide monitoring and prevention to protect kidney health in growth-restricted individuals.