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

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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.

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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

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY, 10032, USA

    Batoule Majed, Natalie Uy & Fangming Lin

  2. Department of Pediatrics, Division of Neonatology, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY, 10032, USA

    David A. Bateman

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  1. Batoule Majed
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  2. David A. Bateman
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  3. Natalie Uy
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  4. Fangming Lin
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Corresponding authors

Correspondence to David A. Bateman or Fangming Lin.

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

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The authors declare that they have no conflict of interest.

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Majed, B., Bateman, D.A., Uy, N. et al. Patent ductus arteriosus is associated with acute kidney injury in the preterm infant. Pediatr Nephrol 34, 1129–1139 (2019). https://doi.org/10.1007/s00467-019-4194-5

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  • DOI: https://doi.org/10.1007/s00467-019-4194-5

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