Early Continuous Renal Replacement Therapy in Cardiogenic Shock Patients with Severe Acute Kidney Injury Undergoing Extracorporeal Membrane Oxygenation

Abstract

Background: Continuous renal replacement therapy (CRRT) may benefit patients requiring extracorporeal membrane oxygenation (ECMO). However, the clinical benefits and timing of CRRT have not been fully elucidated for these patients. Methods: This study was conducted retrospectively at the Taipei Medical University Hospital between January 2008 and December 2010. We included patients who had Acute Kidney Injury Network (AKIN) stage 3 disease at the initiation of ECMO and subsequently underwent CRRT. We excluded patients aged <18 years or those who were chronic dialysis patients. Early dialysis was defined as receiving CRRT <24 h after the initiation of ECMO. The primary outcome was mortality before weaning from ECMO. Results: The median age of the 15 patients included in the study was 72 years. The median interval between ECMO and CRRT was 16 h. No significant difference in survival was observed between the early- and late-dialysis patients (p = 0.58, log-rank test). However, a trend toward a shorter mean duration of ECMO therapy was observed in the early-dialysis patients (124 vs. 169 h, p = 0.16). The median follow-up glomerular filtration rate for the survivors was 38.9 ml/min/1.73 m². Conclusion: No survival benefit is conferred by the use of CRRT within 24 h after initiating ECMO in patients with severe acute kidney injury according to AKIN criteria. © 2014 S. Karger AG, Basel

Incidence and Outcomes of Acute Kidney Injury Requiring Renal Replacement Therapy in Patients on Percutaneous Mechanical Circulatory Support with Impella-CP for Cardiogenic Shock

“…Aside from cardiogenic shock populations, the Impella-CP device is shown to be protective against AKI in patients undergoing high-risk percutaneous coronary intervention [10]. In a single-center study, patients on extracorporeal membrane oxygenation for cardiogenic shock with associated AKI did not have improved short-term survival with RRT [11]. Whether this cohort was more critically ill than the patients we studied is not known.…”

Initiation time of renal replacement therapy on patients with acute kidney injury: A systematic review and meta‐analysis of 8179 participants

“…Overall, 10 randomized and 41 non‐randomized trials fulfilled the inclusion criteria and were included in the meta‐analysis (Fig. ) …”

“…Continued) 95% CI) 0.74 [0.68, 0.81] 71%, <0.001[18][19][20][21][22]46,48,49,[52][53][54]56,[58][59][60][61][62][63][64][65] All-cause mortality for AKI by sample size <0.00119,24,25,28,29,31,32,36,37,[40][41][42][43][46][47][48][49][50][51][52][55][56][57]61,[63][64][65] …”