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Patent ductus arteriosus is associated with acute kidney injury in the preterm infant

  • Batoule Majed
  • David A. BatemanEmail author
  • Natalie Uy
  • Fangming LinEmail author
Original Article

Abstract

Background

This study aimed to test the hypothesis that a patent ductus arteriosus (PDA) is independently associated with acute kidney injury (AKI) in neonates ≤ 28 weeks gestation.

Methods

Preterm infants with echocardiographic diagnosis of moderate-large PDA at age ≤ 30 days were studied retrospectively. AKI, the primary outcome, was defined and staged according to serum creatinine using Kidney Disease Improving Global Outcomes (KDIGO) neonatal criteria. Its association with the timing and duration of PDA, non-steroidal anti-inflammatory drugs (NSAIDs) and other nephrotoxic exposures, gestational age, and other covariates was evaluated using mixed-effects logistic regression models.

Results

Acute Kidney Injury occurred in 49% (101/206) of infants. Moderate-to-large PDA was associated with any-stage AKI (OR 5.31, 95% CI 3.75 to 7.53), stage 1 (mild) AKI (OR 4.86, 95% CI 3.12 to 7.56), and stages 2–3 (severe) AKI (OR 10.9, 95% CI 5.70 to 20.8). NSAID treatment added additional risk for mild AKI (OR 2.45, 95% CI 1.61 to 3.71). Severe AKI was less likely when NSAID treatment was effective (OR 0.45, 95% CI 0.21 to 0.97) but not when ineffective (OR 1.63, 95% CI 0.76 to 3.50).

Conclusions

Moderate-to-large PDA was strongly associated with all stages of AKI in preterm infants ≤ 28 weeks of gestational age. Effective NSAID treatment decreased the risk of severe but not mild AKI. These differential effects reflect the balance between the renal benefits of PDA closure and the risk of NSAID toxicity.

Keywords

Patent ductus arteriosus Acute kidney injury Non-steroidal anti-inflammatory drug 

Abbreviations

PDA

Patent ductus arteriosus

DA

Ductus arteriosus

NSAIDs

Non-steroidal anti-inflammatory drug

AKI

Acute kidney injury

KDIGO

Kidney Disease Improving Global Outcomes

sCr

Serum creatinine

GA

Gestational age

Notes

Acknowledgements

We wish to thank New York Presbyterian Hospital for supporting fellows’ education and research.

Compliance with ethical standards

The hospital institutional review board approved the study protocol and waived the need for consent.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© IPNA 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Division of Pediatric Nephrology, New York Presbyterian Morgan Stanley Children’s HospitalColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Pediatrics, Division of Neonatology, New York Presbyterian Morgan Stanley Children’s HospitalColumbia University Medical CenterNew YorkUSA

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