Assessment of Kidney Function and Acute Kidney Injury following Transcatheter Patent Ductus Arteriosus Closure in Preterm Infants.

OBJECTIVE

Transcatheter patent ductus arteriosus closure (TCPC) has been increasingly used in preterm infants. Hemodynamically significant patent ductus arteriosus (hsPDA) owing to ductal steal and changes in kidney perfusion is associated with the risk of acute kidney injury (AKI) and changes in kidney function. There is limited evidence describing changes in kidney function following TCPC and factors affecting the same. We conducted this study with aim of reviewing the prevalence of AKI and changes in kidney function following TCPC in preterm infants.

STUDY

DESIGN

A single-center retrospective cohort study was conducted to collect data from January 1, 2017, to February 29, 2024. Preterm infants born <29 w of gestational age (GA) receiving TCPC were included in the study. The primary outcome was AKI prevalence and kidney function following TCPC. AKI was defined as per the modified neonatal kidney disease: Improving Global Outcomes (KDIGO) criteria using serum creatinine (SCr) and urine output.

RESULTS

A total of 89 infants fulfilled inclusion criteria. Included infants were predominantly female (50, 59.7%), had median GA of 25 w (IQR: 24-27), and median birth weight of 700 g (IQR: 600-863). AKI developed in five infants (5.6%) following TCPC using SCr criteria. Four infants (4.5%) had stage 1 and one (1.1%) had stage 2 AKI. Overall, 14% reduction in SCr levels was seen following TCPC (median pre-TCPC, 0.28 mg/dL [IQR: 0.21-0.35], median, 5 to 7 days post-TCPC, 0.24 mg/dL [IQR: 0.18-0.29], p < 0.001). Infants who developed AKI had an initial rise in SCr followed by 37% reduction by 5 to 7 days (pre-TCPC: 0.41 mg/dL [IQR: 0.27-0.51]; median, 24 hours post, 0.57 mg/dL [IQR: 0.29-1.22]; median, 5 to 7 days post, 0.26 mg/dL [IQR: 0.19-0.67], p = 0.07).

CONCLUSION

In preterm infants undergoing TCPC, a small percentage of infants developed mild AKI which improved quickly within 1 week post-TCPC. Overall, there was a significant and persistent improvement in kidney function following TCPC.

KEY POINTS: · Incidence of AKI following transcatheter PDA closure is low (5%) and majority had grade 1 AKI.. · Serum Cr levels reduced by 14% within 48 hours of TCPC; reduction was higher in infants with AKI.. · Each day increase in age at time of TCPC was associated with 18% lower odds of developing AKI..