Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Acute kidney injury in infants diagnosed with congenital diaphragmatic hernia

Pediatric Research volume 94, pages 1083–1088 (2023)Cite this article

Abstract

Background

To assess the association and outcomes of acute kidney injury (AKI) in infants diagnosed with congenital diaphragmatic hernia (CDH).

Methods

We analyzed the National Inpatient Sample dataset for the years 2010 through 2018. We evaluated the prevalence and outcomes associated with AKI in infants diagnosed with CDH. Outcomes were assessed using regression analysis while controlling for variables.

Results

A total of 32,042,481 term infants were identified, of them 10,804 had CDH. Prevalence of AKI in infants with CDH was 6.5% compared to 0.05% in those without CDH (aOR = 14.7, CI: 13.0–16.6). ECMO was utilized at 62% of CDH infants that had AKI compared to 17% in infants without AKI (aOR = 4.22, CI: 3.38–5.27). Mortality was greater in CDH infants who developed AKI when compared to those without AKI (57.3 vs. 16.7%, aOR = 3.65, CI: 2.99–4.46). The trend of mortality in CDH infants who developed AKI decreased overtime, p < 0.001, while the trends for mortality in the overall CDH infants and in CDH infants without AKI did not change during the study period, p = 0.12.

Conclusion

AKI is not uncommon in infants diagnosed with CDH. ECMO utilization and mortality are substantially increased in CDH infants when they develop AKI.

Impact

  • Mortality in infants diagnosed with congenital diaphragmatic hernia (CDH) is relatively high despite advances in neonatal care.

  • Infants with CDH are potentially at increased risk of acute kidney injury (AKI).

  • Within CDH population, infants diagnosed with AKI are at increased risk for ECMO use and mortality.

  • This is the largest study to address the association and outcomes of AKI in term infants diagnosed with CDH.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow diagram of the study population.
Fig. 2: Mortality among infants with congenital diaphragmatic hernia in the overall sample and in infants with and without acute kidney injury (AKI).

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this article.

References

  1. Chatterjee, D., Ing, R. J. & Gien, J. Update on congenital diaphragmatic hernia. Anesth. Analg. 131, 808–821 (2020).

    Article  PubMed  Google Scholar 

  2. Graham, G. & Devine, P. C. Antenatal diagnosis of congenital diaphragmatic hernia. Semin. Perinatol. 29, 69–96 (2005).

    Article  PubMed  Google Scholar 

  3. Skari, H., Bjornland, K., Haugen, G., Egeland, T. & Emblem, R. Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J. Pediatr. Surg. 35, 1187–1197 (2000).

    Article  CAS  PubMed  Google Scholar 

  4. Liberio, B. M. et al. Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia. J. Perinatol. 41, 1901–1909 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ryan, A., Gilhooley, M., Patel, N. & Reynolds, B. C. Prevalence of acute kidney injury in neonates with congenital diaphragmatic hernia. Neonatology 117, 88–84 (2020).

    Article  CAS  PubMed  Google Scholar 

  6. Murthy, K. et al. Predicting death or extended length of stay in infants with congenital diaphragmatic hernia. J. Perinatol. 36, 654–659 (2016).

    Article  CAS  PubMed  Google Scholar 

  7. Arattu Thodika, F. M. S., Dassios, T., Deep, A. & Greenough, A. Acute kidney injury in infants with congenital diaphragmatic hernia. J. Perinatol. 42, 925–929 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Elgendy, M. M. et al. Trends and racial disparities for acute kidney injury in premature infants: the US national database. Pediatr. Nephrol. 36, 2789–2795 (2021).

    Article  PubMed  Google Scholar 

  9. Elgendy, M.M., Othman, H.F., Bou Matar, R., Mohamed, A.M., Aly, H. Kidney replacement therapy in neonates: Utilization trends and outcomes. Pediatr. Nephrol. Epub ahead of print. PMID: 35790647 (2022).

  10. Gadepalli, S. K., Selewski, D. T., Drongowski, R. A. & Mychaliska, G. B. Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem. J. Pediatr. Surg. 46, 630–635 (2011).

    Article  PubMed  Google Scholar 

  11. HCUP: hcup-us.ahqr.gov/kidoverview.jsp#structure accessed on 01/31/2021

  12. Charlton, J. R. et al. Late onset neonatal acute kidney injury: results from the AWAKEN Study. Pediatr. Res. 85, 339–348 (2019).

    Article  PubMed  Google Scholar 

  13. Charlton, M. Jr et al. Incidence and risk factors of early onset neonatal AKI. Clin. J. Am. Soc. Nephrol. 14, 184–195 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Grover, T. R., Rintoul, N. E. & Hedrick, H. L. Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia. Semin Perinatol. 42, 96–103 (2018).

    Article  PubMed  Google Scholar 

  15. Shalaby, M. A. et al. Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatr. Nephrol. 33, 1617–1624 (2018).

    Article  PubMed  Google Scholar 

  16. Mugford, M., Elbourne, D. & Field, D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst. Rev. 3, CD001340 (2008).

    Google Scholar 

  17. Fallon, S. C. et al. Repair of congenital diaphragmatic hernias on Extracorporeal Membrane Oxygenation (ECMO): Does early repair improve patient survival? J. Pediatr. Surg. 48, 1172–1176 (2013).

    Article  PubMed  Google Scholar 

  18. Dassinger, M. S. et al. Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation. J. Pediatr. Surg. 45, 693–697 (2010).

    Article  PubMed  Google Scholar 

  19. Askenazi, D. J. et al. Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation. Pediatr. Crit. Care Med. 12, 1–6 (2011).

    Article  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Mohamed A. Mohamed, Hany Aly.

Authors and Affiliations

  1. Department of Neonatology, Cleveland Clinic Children’s, Cleveland, Ohio & Department of Pediatrics, University of Florida, Jacksonville, FL, USA

    Marwa M. Elgendy

  2. Department of Neonatology, Cleveland Clinic Children’s, Cleveland, OH, USA

    Afeez Adisa, Mohsen Farghaly, Mohamed A. Mohamed & Hany Aly

  3. Department of Pediatrics, MetroHealth Medical center, Cleveland, OH, USA

    Mahmoud Ali

Authors
  1. Marwa M. Elgendy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Afeez Adisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohsen Farghaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahmoud Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohamed A. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hany Aly
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.M.E., M.A.M., and H.A. participated in the conception and the design of the work including, the acquisition, analysis, and interpretation of the statistical analyses, drafting the initial manuscript, reviewing, and revision of the manuscript. They coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. A.A., M.F., and M.A. conceptualized and designed the study, carried out the initial analyses, drafted the work and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dr. Mohamed A. Mohamed and Dr. Hany Aly have Joint senior authorship.

Corresponding author

Correspondence to Marwa M. Elgendy.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elgendy, M.M., Adisa, A., Farghaly, M. et al. Acute kidney injury in infants diagnosed with congenital diaphragmatic hernia. Pediatr Res 94, 1083–1088 (2023). https://doi.org/10.1038/s41390-023-02545-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-023-02545-x

This article is cited by

Search

Advanced search

Quick links