Association of patent ductus arteriosus treatment in extremely low gestational age neonates with two year kidney outcomes: a secondary analysis of the preterm erythropoietin neuroprotection trial (PENUT).

Abstract

Background: Management of patent ductus arteriosus (PDA) is variable and includes expectant, medical, and procedural options. Both the hemodynamic effects of a PDA and its treatment put neonates at risk for acute kidney injury (AKI). Little is known about how different management approaches to a PDA, either conservative management or active management and either medical or surgical treatment, in preterm neonates impact kidney function over the longer term. The objective of this study is to evaluate rates of kidney dysfunction at two years of age in extremely low gestational age neonates (ELGANs) with treated compared to untreated PDAs.

Methods: Secondary analysis of prospectively collected data from the PENUT trial. Kidney dysfunction defined by: eGFR < 90 mL/min/1.73 m², systolic or diastolic blood pressures (SBP or DBP) > 90th percentile, or proteinuria measured by albumin to creatinine ratio (ACR) > 30 mg/g. Between-group, variables were compared using chi-square or t-test statistics. General estimating equations and multivariable logistic regression was used to evaluate the association with outcomes.

Results: Of 780 ELGANs, 261 (43%) were treated for PDA. Of those treated, 168 (64.4%) received pharmacologic treatment, 12 (4.6%) received surgical treatment, 57 (21.8%) received both, and 24 (9.2%) were listed as having a treated PDA without specification of management. After adjusting for confounding factors, those actively treated for a PDA were less likely to have SBP > 90th percentile at two years (29.5% treated vs. 34.3% control, adjusted OR 0.59, CI 0.36-0.99). The adjusted odds-ratios for differences in other 2-year kidney outcomes did not differ. Among those medically treated, indomethacin was used more commonly than either ibuprofen or acetaminophen.

Conclusions: ELGANs receiving treatment for a PDA were less likely to have elevated SBP at two years. Prospective studies are needed to examine the effects of a hemodynamically significant PDA and its management on long-term kidney outcomes.