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Am J Perinatol
DOI: 10.1055/a-2779-7276
Review Article

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

Authors

  • Vignesh Gunasekaran  ‡   ‡

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

  • Soowan Woo  ‡   ‡

    2   Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Republic of Korea

  • Andrew M. South

    3   Department of Pediatrics/Section of Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
    4   Division of Public Health Sciences/Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States

  • Jeffrey Shenberger

    5   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut, United States

  • David Askenazi

    6   Department of Pediatrics/Division of Nephrology, The Children's of Alabama, UAB Medicine, Birmingham, Alabama, United States

  • Parvesh M. Garg

    7   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States

Funding Information P.M.G. is partially supported by the NIGMS of the NIH under award number U54GM115428. A.M.S. is supported by NIH NHLBI R01HL146818, NIH NHLBI K23HL148394, and NIH NHLBI R01HL164434. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

Acute kidney injury (AKI) is a clinically significant complication in preterm neonates, leading to increased morbidity, mortality, and risk of long-term kidney dysfunction. Within this vulnerable population, the presence of a hemodynamically significant patent ductus arteriosus (PDA) may further exacerbate AKI risk. The relationship between PDA and AKI is complex, involving both the pathophysiological consequences of altered hemodynamics (e.g., ductal steal) causing renal ischemia and the potential nephrotoxic effects of therapeutic interventions. However, the existing literature provided limited insight into the impact of PDA and its management on AKI in preterm infants, with most studies relying on retrospective designs. There is a notable absence of consensus regarding the comparative effects of conservative, pharmacologic, and surgical PDA management strategies on AKI outcomes. This study directly addresses these knowledge gaps by synthesizing findings from diverse clinical trials, cohort studies, and meta-analyses into a single, comprehensive resource, aiming to inform future research and guide best practices for managing PDA-related AKI in preterm neonates.

Key Points

  • AKI in PDA involves ductal steal and nephrotoxic treatment effects.

  • Early AKI detection in hsPDA requires monitoring and balanced treatment.

  • hsPDA is a major risk factor for AKI in preterm infants.

  • Understanding intervention impact on AKI needs well-designed studies.

Keywords

acute kidney injury - patent ductus arteriosus - preterm infant - catheter closure - PDA treatment

‡ These authors contributed equally to this article.




Publication History

Received: 16 October 2025

Accepted: 24 December 2025

Accepted Manuscript online:
31 December 2025

Article published online:
14 January 2026

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