Risk Factors for Acute Kidney Injury and In-Hospital Mortality in Patients Receiving Extracorporeal Membrane Oxygenation

Abstract

Background and ObjectivesAlthough acute kidney injury (AKI) is the most frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), few studies have been conducted on the risk factors of AKI. We performed this study to identify the risk factors of AKI associated with in-hospital mortality.MethodsData from 322 adult patients receiving ECMO were analyzed. AKI and its stages were defined according to Kidney Disease Improving Global Outcomes (KDIGO) classifications. Variables within 24 h before ECMO insertion were collected and analyzed for the associations with AKI and in-hospital mortality.ResultsStage 3 AKI was associated with in-hospital mortality, with a hazard ratio (HR) (95% CI) of 2.690 (1.472–4.915) compared to non-AKI (p = 0.001). The simplified acute physiology score 2 (SAPS2) and serum sodium level were also associated with in-hospital mortality, with HRs of 1.02 (1.004–1.035) per 1 score increase (p = 0.01) and 1.042 (1.014–1.070) per 1 mmol/L increase (p = 0.003). The initial pump speed of ECMO was significantly related to in-hospital mortality with a HR of 1.333 (1.020–1.742) per 1,000 rpm increase (p = 0.04). The pump speed was also associated with AKI (p = 0.02) and stage 3 AKI (p = 0.03) with ORs (95% CI) of 2.018 (1.129–3.609) and 1.576 (1.058–2.348), respectively. We also found that the red cell distribution width (RDW) above 14.1% was significantly related to stage 3 AKI.ConclusionThe initial pump speed of ECMO was a significant risk factor of in-hospital mortality and AKI in patients receiving ECMO. The RDW was a risk factor of stage 3 AKI.

Prognostic value of Red Blood Cell Distribution Width in Acute Kidney Injury Patients: A Systematic Review and Meta-analysis

“…Although the mechanism of the RDW values in patients with AKI is at present unclear, several potential explanations may account for the relationship between RDW and AKI. Among the risk factors, anemia is the independent related to AKI [46], one present study indicated that the elevated RDW group in AKI was found to have low red blood cell (RBC) which may contribute to increase AKI occurring [28]. Previous studies have demonstrated RDW levels are associated with inflammation and serum antioxidants which mediate effects on RDW through IL-6 [47], and the IL-6 levels in serum may predict the mortality of AKI patients [48].…”

“…included 1251 cases and 1663 controls were identified meeting the criteria for inclusion in our meta-analysis, with publication years ranging from 2015 to 2018 [21,[26][27][28][29][30][31].…”

“…The key features of 8 studies on the association between RDW and AKI are shown in Table 1. In those studies, half of which including Caucasian descents (3 published papers included 4 RCSs) [21,26,27] and the other half of which including Asian descents [28][29][30][31]. All the included studies were prospective cohort studies, and the mean age years of the patient with AKI range from 6.7 to 68.9.…”

Electronic health record-based predictive models for acute kidney injury screening in pediatric inpatients

“…Lower platelet count, lower pH, RDW, and hypotension are known risk factors for AKI. ( 1 , 4 , 6 , 21 , 22 ) One prior study found that younger patients experienced more AKI,( 6 ) while other studies have indicated higher risk in older patients;( 1 , 4 ) associations of young age to AKI are potentially confounded by the low baseline creatinine in the youngest pediatric patients, leading to AKI diagnosis via 1.5-fold creatinine increase without clinically meaningful reduction in renal function. Other results were unexpected, such as the stronger association of moderate risk nephrotoxins than high risk nephrotoxins to AKI, which may be due to clinicians avoiding known nephrotoxic medications in children with suspected renal insufficiency.…”

The Effects of Pre-Existing Hyponatremia and Subsequent-Developing Acute Kidney Injury on In-Hospital Mortality: A Retrospective Cohort Study

“…Acute kidney injury (AKI) is also a common, but harmful disease [ 9 ]. As with hyponatremia, the presence of AKI is dangerous since it predicts mortality in critically or non-critically ill hospitalized patients [ 10 , 11 ] and in community based patients [ 12 ]. There are several causes of AKI such as volume depletion [ 13 ] or overload [ 14 , 15 ], sepsis [ 16 ], and heart [ 17 ] and liver [ 18 ] disease.…”