SHARE @ Advocate Health - Midwest - Scientific Day: Exploring the Association Between Patent Ductus Arteriosus, its Management, and Acute Kidney Injury in Preterm Neonates
 

Affiliations

Advocate Children’s Hospital, Advocate Lutheran General Hospital

Abstract

Background/Significance:

Acute kidney injury (AKI) remains under-recognized in preterm infants. While modified KDIGO criteria guides neonatal AKI diagnosis, the relationship between patent ductus arteriosus (PDA), its management, and AKI development remains unclear. The "ductal steal" phenomenon in PDA may contribute to renal hypoperfusion and AKI.

Purpose:

To determine AKI frequency using modified neonatal KDIGO criteria in patients <30 weeks gestational age (GA) with PDA, examine the impact of PDA management on AKI, and explore the association between echocardiographic markers and AKI.

Methods:

This single-center retrospective study focused on preterm infants born at <30 weeks GA between February 2019 and September 2023. The cohort was categorized by PDA status and AKI stages using the modified KDIGO 2016 criteria. Statistical significance was determined at p<0.05.

Results:

Among 166 infants (mean GA 27.1±1.98 weeks, birth weight 1004±315g), the incidence of KDIGO-defined AKI was 80.1%, while clinically coded AKI was only 8.5%, indicating significant under-recognition. In documented PDA cases (n=115), the incidence of AKI was higher with PDA (87% vs 72%, p=0.047). The distribution of AKI severity showed a non-significant trend toward higher stages with PDA (p=0.063). PDA management strategy and severity did not significantly affect AKI occurrence. Echocardiographic findings of reversed diastolic flow showed no significant association with AKI.

Conclusion:

The significantly higher AKI incidence in infants with PDA underscores its role as a risk factor, though management approach and PDA severity did not impact AKI development. The marked disparity between KDIGO-identified and clinically coded AKI highlights the need for improved recognition and systematic kidney function monitoring in preterm infants with PDA.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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Document Type

Poster


 

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May 21st, 11:41 AM May 21st, 1:15 PM

Exploring the Association Between Patent Ductus Arteriosus, its Management, and Acute Kidney Injury in Preterm Neonates

Background/Significance:

Acute kidney injury (AKI) remains under-recognized in preterm infants. While modified KDIGO criteria guides neonatal AKI diagnosis, the relationship between patent ductus arteriosus (PDA), its management, and AKI development remains unclear. The "ductal steal" phenomenon in PDA may contribute to renal hypoperfusion and AKI.

Purpose:

To determine AKI frequency using modified neonatal KDIGO criteria in patients <30 weeks gestational age>(GA) with PDA, examine the impact of PDA management on AKI, and explore the association between echocardiographic markers and AKI.

Methods:

This single-center retrospective study focused on preterm infants born at <30 weeks GA between February 2019 and September 2023. The cohort was categorized by PDA status and AKI stages using the modified KDIGO 2016 criteria. Statistical significance was determined at>p<0.05.

Results:

Among 166 infants (mean GA 27.1±1.98 weeks, birth weight 1004±315g), the incidence of KDIGO-defined AKI was 80.1%, while clinically coded AKI was only 8.5%, indicating significant under-recognition. In documented PDA cases (n=115), the incidence of AKI was higher with PDA (87% vs 72%, p=0.047). The distribution of AKI severity showed a non-significant trend toward higher stages with PDA (p=0.063). PDA management strategy and severity did not significantly affect AKI occurrence. Echocardiographic findings of reversed diastolic flow showed no significant association with AKI.

Conclusion:

The significantly higher AKI incidence in infants with PDA underscores its role as a risk factor, though management approach and PDA severity did not impact AKI development. The marked disparity between KDIGO-identified and clinically coded AKI highlights the need for improved recognition and systematic kidney function monitoring in preterm infants with PDA.

 

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