Association between famine exposure during early life and the risk of chronic kidney disease in adulthood: a systematic review and meta-analysis

BACKGROUND: The association between famine exposure and chronic kidney disease (CKD) remains controversial. Our study aimed to consolidate the available data and quantify the effects of early-life starvation on the risk of CKD in adulthood. METHODS: PubMed, Cochrane Library, Embase, Web of Science, Scopus and gray literature were searched on January 23, 2025. Random-effects meta-analyses were used to summarize the odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). RESULTS: This study included 7 published articles (4 cohort and 3 cross-sectional studies) with 29 360 subjects. Compared with no exposure to famine, early-life exposure dramatically increased the risk of CKD in adulthood (OR = 1.45, 95% CI: 1.08, 1.82). The summarized ORs differed in terms of sample size, publication year, study type and sex. A significantly elevated risk of CKD was discovered in studies with sample sizes exceeding 2000 individuals (OR = 1.53, 95% CI: 1.11, 1.94), studies published after 2020 (OR = 1.91, 95% CI: 1.60, 2.23), and cohort studies (OR = 1.65, 95% CI: 1.12, 2.19), and for males exposed to famine (OR = 1.76, 95% CI: 1.10, 2.42). Furthermore, the creatinine level was substantially higher in the exposure group (WMD = 2.82 μmol/L, 95% CI: 2.09, 3.54) than in the unexposed group. In contrast to the creatinine level, the estimated glomerular filtration rate (eGFR) was significantly lower in the exposure group (WMD = -8.88 mL/min/1.73 m2, 95% CI: -10.67, -7.09). CONCLUSIONS: Our findings indicate that famine exposure is correlated with an increased risk of developing CKD over one's lifetime. The risk may vary with sample size, publication year, study type, and sex.