Low birth weights contribute to the high rates of early-onset chronic renal failure in the southeastern United States

Background: The southeastern United States is a region in which rates of ca rdiovascular and renal diseases are excessive. Within the Southeast, South Carolina has unusually high rates of end-stage renal disease (ESRD) in youn g people, with more than 70% of cases attributed to hypertension and diabet es. Objective: To determine whether the increased vulnerability to early-onset ESRD might originate through impaired renal development in utero as measure d by low birth weight. Methods: Patients who were diagnosed with renal failure and undergoing dial ysis from 1991 through 1996 were identified from the ESRD registry maintain ed by the Southeastern Kidney Council, Raleigh, NC. Birth weights reported on birth certificates were selected for the ESRD cases and non-ESRD control s who were born in South Carolina in 1950 and later. Birth weights were com pared for 1230 cases and 2460 controls who were matched for age, sex, and r ace. Results: Low birth weight was associated with ESRD among men and women as w ell as blacks and whites. Among people whose birth weight was less than 2.5 kg, the odds ratio for ESRD was 1.4 (95% confidence interval, 1.1-1.8) com pared with people who weighed 3 to 3.5 kg. This association was present for renal failure resulting from diabetes, hypertension, and other causes. Conclusions: Low birth weights, which reflect adverse effects on developmen t in utero, contribute to the early onset of ESRD in South Carolina. Since low birth weight increases the risk of ESRD from multiple causes, the data suggest that an adverse environment in utero impairs kidney development and makes it more vulnerable to damage from a range of pathological processes.