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Understanding the Impact of Patent Ductus Arteriosus and Treatment Strategies on Acute Kidney Injury in Preterm

Vignesh Gunasekaran1, Soowan Woo2, Andrew Michael South3,4

  • 1Department of Pediatrics/Neonatology, West Virginia University School of Medicine, Martinsburg, West Virginia, United States.

American Journal of Perinatology
|December 31, 2025
PubMed

Insights

Patent ductus arteriosus (PDA) complicates acute kidney injury (AKI) in preterm infants. This review synthesizes evidence on PDA management strategies and their impact on AKI, addressing critical knowledge gaps.

Area of Science:

  • Neonatology
  • Pediatric Nephrology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is a significant complication in preterm neonates, associated with adverse outcomes.
  • Hemodynamically significant patent ductus arteriosus (PDA) may worsen AKI through renal ischemia and therapeutic interventions.
  • Limited research exists on the impact of PDA management on AKI in preterm infants, with a lack of consensus.

Purpose of the Study:

  • To synthesize current evidence on the relationship between PDA and AKI in preterm neonates.
  • To evaluate the impact of different PDA management strategies (conservative, pharmacologic, surgical) on AKI outcomes.
  • To identify knowledge gaps and inform future research and clinical practice.

Main Methods:

  • Comprehensive literature review of clinical trials, cohort studies, and meta-analyses.
  • Synthesis of data focusing on PDA and AKI in preterm infants.
  • Analysis of comparative effects of various PDA management approaches.

Main Results:

  • The relationship between PDA and AKI is multifactorial, involving hemodynamic changes and treatment effects.
  • Evidence on the comparative efficacy of PDA management strategies for AKI prevention/treatment is limited and often retrospective.
  • Significant heterogeneity exists in reported AKI outcomes across different studies and management approaches.

Conclusions:

  • There is a critical need for high-quality research to clarify the impact of PDA management on AKI in preterm neonates.
  • Standardized definitions and outcome measures for AKI in this population are essential.
  • Evidence-based guidelines are needed to optimize PDA management for renal protection in preterm infants.

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