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Kidney Week

Abstract: PO2291

The Association Between Infantile Pulmonary Hypertension, Sildenafil, and AKI During Hospitalization

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Zangla, Emily E., University Hospitals, Rainbow Babies and Children’s Hospital, Department of Nephrology, Cleveland, Ohio, United States
  • Joyce, Emily Lauren, University Hospitals, Rainbow Babies and Children’s Hospital, Department of Nephrology, Cleveland, Ohio, United States
Background

Pulmonary hypertension (pHTN) is a nidus for poor organ perfusion, and is an understudied potential risk factor for acute kidney injury (AKI) in infants. Neither the association between pHTN and AKI, nor treatment with phosphodiesterase-5 inhibitors (i.e. sildenafil) on renal recovery have been elucidated. We sought to describe AKI in a cohort of hospitalized infants with pHTN.

Methods

A retrospective chart review was performed on 18 infants (less than 1 year of age) during the initial hospitalization for diagnosis of pHTN over one year at a single institution. Adapted neonatal KDIGO criteria was utilized to determine presence of AKI during the hospitalization for each patient.

Results

Out of 18 infants with pHTN, 50% developed AKI during hospitalization. Those who developed AKI were older at the age of diagnosis of pHTN (p = 0.04) and more likely to be treated with sildenafil (p = 0.02). Within the cohort, 7 (39%) were treated with sildenafil. On univariate analysis, treatment with sildenafil was associated with increased odds of developing AKI (OR 6.7, 95% CI 0.81-55.0). Of those treated with sildenafil who developed AKI, 80% (4/5) developed AKI before initiation of treatment and 20% (1/5) developed AKI after initiation of treatment.

Conclusion

AKI is prevalent in infants diagnosed with pHTN. The increased odds of developing AKI in patients treated with sildenafil is likely a reflection of severity of illness, as most patients developed AKI prior to initiation of treatment. Further research is needed to evaluate the association between pHTN and AKI, as well as determine the role of sildenafil treatment in preventing AKI or promoting renal recovery.

Descriptive Characteristics
 No AKI
N = 9/18 (50%)
AKI
N = 9/18 (50%)
p-value
Age at diagnosis (mos), mean1.6 ± 2.13.8 ± 2.10.04
Gestational Age (weeks), mean33 ± 6.830 ± 7.30.36
Males, N (%)5 (56%)4 (44%)0.64
Length of stay (days), mean 170± 195169 ± 950.99
Treated with Sildenafil, N (%)2 (29%)5 (71%)0.07
Mortality, N (%)01 (11%)0.30