Chronic kidney disease (CKD) involves long-term structural and functional changes in the kidneys resulting from a variety of underlying causes (1). It has become a significant public health issue. The prevalence of CKD has been steadily increasing, which has placed a considerable burden on healthcare systems. The disease’s impact is not only limited to individuals but also extends to society due to the associated healthcare costs and loss of productivity. Various factors contribute to the rise in CKD cases, including the growing prevalence of diabetes and hypertension, which are key risk factors for kidney damage. The global focus on CKD underscores the need for effective preventive measures, early diagnosis, and management strategies to mitigate its impact (2, 3). In China, CKD has become notably prevalent among adults, reflecting a concerning trend in the country’s public health landscape. Data from 2019 reveals that there were approximately 150.5 million cases of CKD, representing 10.6% of the adult population. This figure highlights the widespread nature of the disease and its significant impact on the Chinese population. Additionally, there were 196,726 deaths attributed to CKD in the same year. Looking ahead, projections suggest that the prevalence of CKD in China will increase to 11.7% by 2029, with mortality rates rising to 17.1 per 100,000 individuals (4). These trends emphasize the urgent need for comprehensive strategies to address and manage CKD effectively in the coming years.

Factors of CKD are extremely complex. Well-documented major factors contributing to various health conditions encompass a range of genetic, physiological, and lifestyle elements. Except for these factors mentioned above, recent life-course epidemiological studies suggest 15–20% of adult CKD risk may originate in early developmental periods (5). The Developmental Origins of Health and Disease (DOHaD) framework, pioneered by Barker and colleagues (6), posits that developmental plasticity during critical early-life periods allows organisms to adapt to suboptimal environments (e.g., malnutrition, psychosocial stress) through persistent metabolic and epigenetic reprogramming - a survival advantage evolutionarily that paradoxically elevates susceptibility to cardiorenal diseases in later life (7). Substantial evidence links specific developmental insults (e.g., intrauterine growth restriction, childhood malnutrition) with reduced nephron endowment and accelerated renal function decline (8, 9). Nevertheless, current DOHaD-CKD epidemiology predominantly relies on extreme-exposure cohorts, particularly famine studies (Dutch Hunger Winter; Chinese Great Famine) that quantify severe but transient malnutrition (10, 11). While these provide mechanistic insights, they represent “natural experiments” with limited generalizability to contemporary populations experiencing moderate yet chronic developmental adversities - a critical gap given rising childhood obesity/micronutrient deficiencies in transitional economies. This study innovatively employs self-reported childhood health as a composite exposure metric capturing nutritional, infectious, and psychosocial stressors across development. Although retrospective recall may introduce non-differential misclassification, this approach enables cost-effective assessment of developmental origins in settings lacking longitudinal biomedical data - a methodological advance for DOHaD research in resource-constrained regions.

Self-reported childhood health is a key indicator of early-life health and a crucial element of adverse childhood experiences (ACEs). Studies have found that poor self-reported childhood health correlates with the number of adverse childhood experiences reported (12). Growing evidence has linked ACEs to conditions such as hypertension (13), diabetes (14), cardiovascular diseases (15, 16). However, whether self-reported childhood health predicts adult CKD incidence independent of traditional risk factor remains unclear, which was important for the DOHaD framework, highlighting how subjective childhood health perceptions may capture synergistic biological and socioeconomic pathways to CKD risk.

This study uses data from wave 3 of the China Health and Retirement Longitudinal Study (CHARLS) to examine whether self-reported childhood health predicts adult CKD incidence independent of traditional risk factors, while also assessing potential gender differences in this association, which could inform life-course prevention strategies by identifying at-risk populations through simple retrospective screening.

Table 1 provides a summary of the participants’ basic characteristics. The study included a total of 12,609 individuals, with a chronic kidney disease (CKD) prevalence of 11.7% (1,480/12,609) among Chinese adults. Analysis by self-reported childhood health status reveals a significant upward trend in CKD prevalence from those reporting excellent to poor childhood health (Figure 2). There were significant differences in the distribution of age groups, sex, region, traditional Chinese medicine (TCM) use, education level, smoking, drinking, BMI categories, hypertension, diabetes, marital status, and annual household income between participants with CKD and those without (p < 0.05). However, no significant difference in physical activity levels was observed between these groups (p = 0.352).

Table 2 displays variations in the estimated Glomerular Filtration Rate (eGFR) across different childhood health statuses. The mean eGFR levels differed significantly among these statuses (p < 0.001). Both the Fair and Poor health groups exhibited lower eGFR levels compared to the excellent group. In gender-stratified analysis, females in the Fair group had significantly lower eGFR levels than those in the Excellent group (p = 0.007). Similar associations were observed when stratifying by region, smoking status, alcohol consumption, physical activity, diabetes, and hypertension.

Table 3 details the relationship between self-reported childhood health status and CKD risk in adulthood. Relative to the Excellent group, the Fair (OR = 1.15; 95% CI: 1.02–1.28; p = 0.018) and Poor groups (OR = 1.38; 95% CI: 1.12–1.70; p = 0.002) exhibited higher CKD risk. Even after adjusting for age, sex, smoking, alcohol consumption, physical activity, highest education level, and TCM use (OR = 1.25; 95% CI: 1.01–1.54; p = 0.042), as well as additional adjustments for diabetes, hypertension, BMI category, marital status, and annual household income (OR = 1.24; 95% CI: 1.01–1.54; p = 0.047), the risk for the Poor group remained elevated by 25 and 24%, respectively.

Table 4 presents a stratified analysis of the association between childhood self-reported health status and adult CKD risk. In the age group of 55–64 years, the Poor group demonstrated a higher CKD risk compared to the Excellent group (p = 0.004). Moreover, a significant interaction was noted between age group and CKD risk within the Poor group (p for interaction = 0.003), and the highest education attainment and CKD risk (p for interaction <0.05).

The present study utilized data from Wave 3 of the China Health and Retirement Longitudinal Survey to investigate the association between childhood self-reported health status and the risk of chronic kidney disease (CKD) in adulthood. The analysis revealed that the prevalence of CKD among Chinese adults aged 45 years and older is 11.7%. Furthermore, a self-reported poor health status during childhood was found to be significantly associated with an increased risk of CKD in adulthood. These results suggest that poor health during childhood may constitute a significant risk factor for the development of CKD. Indicating that self-reported childhood health could predicts adult CKD incidence independent of traditional risk factors, and simple self-reported childhood health screening could enhance CKD risk stratification in primary care settings. To mitigate the prevalence and associated burden of CKD, it is essential to prioritize the improvement of general health conditions in children.

The prevalence of chronic kidney disease among Chinese adults has been notably high over recent decades. This study found that in 2015, the prevalence of CKD among Chinese adults was 11.7%, which is marginally higher than the figure reported in earlier research (20). Liyanage et al. reported a CKD prevalence of 9.2% (95% CI: 7.4–11.0) based on a population-based study in China (20). Conversely, Zhang et al., employing a multistage, stratified sampling method to obtain a representative sample from 13 provinces, reported a CKD prevalence of 10.8% (95% CI: 10.2–11.3) in 2010 (21). This figure is closely aligned with the current study’s prevalence rate of 11.7%. The observed discrepancy may be attributable to differences in the definitions of CKD used in the studies. Our study defined CKD based on estimated Glomerular Filtration Rate (eGFR) as per the CKD-EPI equation and self-reported physician-diagnosed kidney disease. In contrast, Zhang et al.’s study defined CKD using eGFR and albuminuria.

This study represents the first investigation into the association between self-reported health status during childhood and the risk of chronic kidney disease in adulthood. After controlling for various covariates, it was found that individuals who reported poor health status in childhood had a 1.24-fold increased risk of CKD compared to those who reported excellent childhood health. This indicates that poor childhood health status is associated with a 24% higher risk of developing CKD in adulthood. Although previous research, including numerous original studies, systematic reviews, and meta-analyses, has identified adverse childhood experiences—including health status—as significant risk factors for a range of health outcomes, including 23 different conditions, the specific relationship between adverse childhood experiences and CKD risk has not been thoroughly explored (15, 16, 22–24).

Several mechanisms may elucidate the association between self-reported childhood health status and the risk of chronic kidney disease (CKD) in later life. Firstly, poor health during childhood could result in a reduced number of nephrons, diminished kidney size, and, in some cases, impaired renal function. Evidence from human autopsy and epidemiological studies indicates that children born preterm often exhibit a lower nephron count, reduced kidney size, and, occasionally, compromised renal function (25, 26). Secondly, individuals with poor childhood health status exhibit a higher prevalence of hypertension and diabetes compared to those with better childhood health (13, 14), and both hypertension and diabetes are significant risk factors for CKD (27–30). Thirdly, poor childhood health may be associated with elevated levels of oxidative stress (31), which is another recognized risk factor for CKD (32, 33). Moreover, developmental origins hypothesis indicated that adverse childhood experiences could change the epigenetic characteristics (34), which had been documented could elevate the risk of chronic kidney disease in adulthood (35).

Furthermore, the present study conducted a series of stratification analyses, revealing that the relationship between childhood self-reported health status and adult CKD risk varies across different age groups. Specifically, the association appears to be stronger in the 54–65 age group compared to other subgroups (P for interaction = 0.003). This variability may be attributed to the natural history of CKD and survivorship bias. In the 45–54 age group, there may be a higher proportion of preclinical cases (36). Conversely, in the older age group (above 65 years), a greater number of individuals with CKD may have died due to CKD or related diseases and complications (37).

Although the current study utilized National Wave 3 follow-up data from the Chinese Health and Retirement Longitudinal Survey to investigate the association between self-reported childhood health status and the risk of CKD in adulthood, several limitations must be acknowledged. First, the definition of CKD in this study is based on estimated glomerular filtration rate and self-reported diagnoses by physicians. Self-reported disease information may be subject to information bias, including non-differential misclassification bias. Nonetheless, since the CHARLS survey relies on clinical history records for self-reported disease information, this helps mitigate information bias. Second, residual confounding remains a concern in the observed association, as factors such as birth weight and delivery mode were not adjusted for in the logistic regression model. Third, the cross-sectional design of the study imposes limitations on establishing causality between self-reported childhood health status and the risk of CKD in adulthood. Fourth, the assessment of childhood health conditions via a standardized questionnaire, which relied on participants’ recall of past events, may introduce potential recall bias due to the retrospective nature of data. However. It provides cost-effective longitudinal data on early-life health exposures that are often unavailable in medical records, particularly in low- and middle-income country contexts.

Chronic kidney disease is prevalent among adults in China, and there is a notable association between self-reported childhood health status and the risk of developing chronic kidney disease in adulthood. This relationship appears to be specific to different age groups.