Impact of transcatheter PDA closure on renal function in extremely low birth weight infants-a multicenter study

To describe the impact of transcatheter PDA closure on renal function in these premature infants with and without pre-existing renal insufficiency.

This retrospective study was conducted by 4 U.S. pediatric centers and included 245 eligible patients who underwent successful transcatheter PDA device closure. Renal insufficiency in these patients was noted along with risk factors. Renal function over multiple time periods was assessed out to 2 months post intervention.

In total, 245 eligible patients underwent successful transcatheter PDA device closure. In the first 24 h post device closure, the urine output increased from 3.7  to 4.1 ml/kg/h (p < 0.001) with a decrease in serum creatinine (0.40  to 0.37 mg/dL, p < 0.001) and blood urea nitrogen (16  to 12 mg/dL, p < 0.001). This trend of improved renal function continued through 2 months post-device closure. A total of 59 patients (32%) met the definition for acute renal insufficiency prior to cardiac catheterization. The serum creatinine and BUN had a significantly greater decline from baseline for the AKI cohort in comparison to all others at both 1 week post procedure (-0.21 ± 0.04 vs -0.04 ± 0.03, P < 0.0001 and -8.4 ± 1.8 vs -2.4 ± 1.4, P < 0.001) and 1 month post procedure (-0.39 ± 0.04 vs -0.07 ± 0.03, P < 0.0001 and -12.0 ± 1.8 vs -2.3 ± 1.5, P < 0.0001).

All patients showed a positive trend in renal function post PDA device closure with a significant increase in urine output in the first 24 h post closure. Patients with acute renal insufficiency experienced notable improvement in renal function post PDA device closure, even with the use of contrast.