Eur J Pediatr

. 2025 Oct 10;184(11):673.

 doi: 10.1007/s00431-025-06513-x. https://pubmed.ncbi.nlm.nih.gov/41073848/

Incidence of and risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia

Andreas Andersson ^1 2, Bernhard Sedlacek ³, Jonas Berner ^4 5, Carmen Mesas Burgos ^6 7, Johan Mårtensson ^4 8, Åke Norberg ^8 9, Urban Fläring ^3 4

Affiliations Expand

• PMID: 41073848
• PMCID: PMC12513905
• DOI: 10.1007/s00431-025-06513-x

Abstract

Congenital diaphragmatic hernia (CDH) is a severe congenital malformation requiring surgery in the neonatal period. Neonates with CDH are exposed to several possible risk factors for acute kidney injury (AKI). Still, data on the incidence of and risk factors for AKI in this group of patients are sparse. Our aim was to investigate the AKI incidence and identify modifiable risk factors in a cohort of CDH patients thoroughly characterized in physiological and clinical variables. The primary outcome was the frequency of AKI according to the KDIGO definition. This was a retrospective cohort study including 109 newborn CDH patients with birth weight ≥ 2 kg, GA ≥ 32 weeks, and invasive ventilation initiated within 2 days. Thirty-one patients (28%, 95% CI 21-38) developed AKI, of which 17 (55%) had stage 1, 1 (3%) stage 2, and 13 (42%) stage 3 AKI. Continuous renal replacement therapy was needed in 13 (42%) patients, 12 of these during ECMO treatment. Duration of hyperchloremia prior to AKI was found to be a possibly modifiable risk factor for AKI (p = 0.0006). Peak Oxygenation Index (p = 0.02) and Vasoactive-Inotropic Score (p = 0.0004) were also independently associated with AKI. There was complete resolution of AKI at PICU discharge in all surviving patients. Mortality in included patients was 6/109 (5.5%, 95% CI 2-12).

Conclusion: In this cohort, the majority of AKI cases were mild, and surviving patients recovered from AKI before PICU discharge. Almost all cases of severe AKI occurred in ECMO patients. Hyperchloremia could be a modifiable risk factor for the development of AKI in CDH patients.

What is known: • Congenital diaphragmatic hernia (CDH) is a congenital malformation with severe cardiorespiratory instability and considerable mortality. The incidence of and risk factors for acute kidney injury (AKI) in CDH patients need further investigation.

What is new: • The overall rate of AKI was 28 % (95% CI 21-38). The majority of AKI cases were mild, and surviving patients recovered from AKI before PICU discharge. • Hyperchloremia was identified as a potentially modifiable risk factor for AKI development.

Keywords: Acute kidney injury; Congenital diaphragmatic hernia; Continuous renal replacement therapy; Fluid balance; Neonate.

© 2025. The Author(s).