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Daniel T. Lackland, DrPH; Holly E. Bendall, MSc; Clive Osmond, PhD; Brent M. Egan, MD; David J. P. Barker, MD, PhD

Arch Intern Med. 2000;160:1472-1476.

Background  The southeastern United States is a region in which rates of cardiovascular and renal diseases are excessive. Within the Southeast, South Carolina has unusually high rates of end-stage renal disease (ESRD) in young people, with more than 70% of cases attributed to hypertension and diabetes.

Objective  To determine whether the increased vulnerability to early-onset ESRD might originate through impaired renal development in utero as measured by low birth weight.

Methods  Patients who were diagnosed with renal failure and undergoing dialysis from 1991 through 1996 were identified from the ESRD registry maintained by the Southeastern Kidney Council, Raleigh, NC. Birth weights reported on birth certificates were selected for the ESRD cases and non-ESRD controls who were born in South Carolina in 1950 and later. Birth weights were compared for 1230 cases and 2460 controls who were matched for age, sex, and race.

Results  Low birth weight was associated with ESRD among men and women as well 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) compared 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 development 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.

From the Departments of Biometry and Epidemiology (Dr Lackland) and Pharmacology (Dr Egan), Medical University of South Carolina, Charleston, and Medical Research Council, Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England (Ms Bendall and Drs Osmond and Barker).

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