A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group

• Published in: The Lancet (British edition) 2017-07, Vol.390 (10092), p.424-428
• Main Authors: Luyckx, Valerie A, MBBCh, Perico, Norberto, MD, Somaschini, Marco, MD, Manfellotto, Dario, Prof, Valensise, Herbert, Prof, Cetin, Irene, Prof, Simeoni, Umberto, Prof, Allegaert, Karel, PhD, Vikse, Bjorn Egil, Prof, Steegers, Eric A, Prof, Adu, Dwomoa, MD, Montini, Giovanni, Prof, Remuzzi, Giuseppe, Prof, Brenner, Barry M, Prof
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - pathology; Babies; Birth Weight; Cardiovascular diseases; Developmental biology; Dialysis; Gestational Age; Health risk assessment; Humans; Hypertension; Hypertension, Renal - embryology; Hypertension, Renal - pathology; Hypertension, Renal - prevention & control; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Internal Medicine; Kidney - embryology; Kidney - growth & development; Kidney - pathology; Kidney diseases; Kidney Diseases - embryology; Kidney Diseases - pathology; Kidney Diseases - prevention & control; Kidneys; Low birth weight; Low income areas; Maternal & child health; Nephrons - pathology; Population Surveillance - methods; Poverty; Prenatal Care - methods; Prevention; Risk factors; Sustainable development
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(17)30576-7

Developmental programming in the kidney has been recognised for more than two decades, but its contribution to the global burden of kidney diseases remains underappreciated by policy makers.3 In view of the many factors known to affect fetal kidney development, including maternal health and nutrition, exposure to stress, poverty, pollutants, drugs, and infections during gestation,3 a holistic strategy to prevent such programming effects is consistent with the life-course approach and aligns with the United Nations (UN) Sustainable Development Goals to foster health.2 Chronic kidney disease is an important contributor to the NCD burden that has been relatively neglected in WHO's Global Action Plan for the Prevention and Control of NCDs, despite chronic kidney disease being a major cause of hypertension and a major risk multiplier of cardiovascular disease.1,4 Although the prevalence of chronic kidney disease in many low-income countries remains unknown, the disease is most prevalent among disadvantaged populations within industrialised nations-eg, African-Americans and Aboriginal Australians.5 The number of people receiving dialysis or transplantation is projected to double, from 2·6 million in 2010 to 5·4 million in 2030.6 In 2010, 2·3-7·1 million adults died from lack of access to dialysis and transplantation in low-income countries.6 In view of the clinical outcomes and often prohibitively high costs of treatment, prevention and early detection are the only sustainable solutions to address this growing global burden. 16