Relationship Between Renal Function and Extracorporeal Membrane Oxygenation Use: A Single-Center Experience

Abstract

The effects of extracorporeal membrane oxygenation (ECMO) support on renal function in children with critical illness are unknown. The objective of this study was to investigate the impact of ECMO on renal function among children in different age groups. We performed a single-center retrospective observational study in critically ill children ≤ 18 years supported on ECMO for refractory cardiac or pulmonary failure (2006-2012). The patient population was divided into four age groups for the purpose of comparisons. The Acute Kidney Injury Network's (AKIN's) validated, three-tiered staging system for acute kidney injury was used to categorize the degree of worsening renal function. Data on patient demographics, baseline characteristics, renal function parameters, dialysis, ultrafiltration, duration of mechanical cardiac support, and mortality were collected. Comparisons of baseline characteristics, duration of mechanical cardiac support, and renal function were made between the four age groups. During the study period, 311 patients qualified for inclusion, of whom 289 patients (94%) received venoarterial (VA) ECMO, 12 (4%) received venovenous (VV) ECMO, and 8 (3%) received both VV and VA ECMO. A total of 109 patients (36%) received ultrafiltration on ECMO, 58 (19%) received hemodialysis, and 51 (16%) received peritoneal dialysis. There was a steady and sustained improvement in renal function in all age groups during the ECMO run, with the maximum and longest-sustained improvement occurring in the oldest age group. Proportions of patients in different AKIN stages remained similar in the first 7 days after ECMO initiation. We demonstrate that renal dysfunction improves early after ECMO support. Irrespective of the underlying disease process or patient age, renal function improves in children with pulmonary or cardiac failure who are placed on ECMO.

Predictors of Acute Renal Failure During Extracorporeal Membrane Oxygenation in Pediatric Patients After Cardiac Surgery

“…On the basis of our study, the ECMO duration was longer in the ARF group than that in the non‐ARF group, which supports the result of Gupta et al . Long duration of ECMO support was a risk factor of ARF in pediatric cardiac patients during ECMO .…”

“…This study manifested that the incidence of ARF was 40.5% in pediatric patients after cardiac surgery requiring ECMO support. This result was higher than that in other reports (16–37%) . Open cardiac surgery leads to acute kidney injury (49.9%) .…”

Development and Validation of a Score to Predict Mortality in Children Undergoing Extracorporeal Membrane Oxygenation for Respiratory Failure: Pediatric Pulmonary Rescue With Extracorporeal Membrane Oxygenation Prediction Score*

“…(6, 13, 21–23) Although timing of injuries is not reported to ELSO, Gupta found that renal function commonly improved after ECMO initiation suggesting most acute kidney injury occurs prior to ECMO. (24)…”

Pharmacokinetics and Safety of Micafungin in Infants Supported With Extracorporeal Membrane Oxygenation

“…34 Limited metabolism also occurs in the liver by arylsulfatase and catechol-O-methyltransferase into metabolites with little or no antifungal activity. 15 While the impact of ECMO on renal dysfunction is well described, 35 the effect of ECMO on hepatic transporters and metabolic capacity is unknown. Micafungin PK studies in adults with severe hepatic dysfunction, revealed lower micafungin exposure and higher CL compared with healthy controls.…”