The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy

Abstract

Acute kidney injury (AKI) is common in patients treated with veno-arterial (VA-) or veno-venous (VV-) extracorporeal membrane oxygenation (ECMO). In this setting, the use of continuous renal replacement therapy (CRRT) can help to optimize fluid status but may also negatively impact on patients' outcome. In contrast, the relationship between AKI, CRRT, and survival in critically ill adult patients receiving ECMO is not well defined. The institutional ECMO database (n = 162) from November 2008 to December 2013, excluding patients with ICU survival <24 hours was reviewed. Demographics, co-morbidities, and concomitant therapies for all patients were collected. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. ICU mortality was noted. Data were retrieved for 135 patients (79 with VA-ECMO and 56 with VV-ECMO). Of these, 95 developed AKI, 63 (47%) of whom required CRRT; thus three groups of patients were identified: (a) no AKI; (b) AKI without CRRT (AKINOCRRT ); and (c) CRRT with AKI (AKICRRT ). AKINOCCRT patients were more likely to have preexisting heart disease, to be more severely ill, and to be treated with VA-ECMO than those without AKI. AKICRRT patients were also more likely to be treated with VA-ECMO, had more organ dysfunction at the time of ECMO insertion, and needed more transfusions and inotropic agents than patients without AKI. ICU mortality was 53% (72/135) and was similar in the three groups, even when different AKI stages or VA/VV-ECMO were analyzed separately. In this study, the use of CRRT was not associated with an increased mortality in an adult population of patients treated with ECMO, even after adjustment for confounders.

Factors associated with major adverse kidney events in patients who underwent veno-arterial extracorporeal membrane oxygenation

“…AKI occurs very frequently in patients undergoing VA-ECMO. The prevalence in our study was about 92% while the prevalence of AKI in ICU patients has been estimated between 25 and 50% and between 70 and 85% in patients who underwent ECMO [12][13][14][15][16]. Comparing our findings with the latter results is challenging since the classification used, the population involved and the type of ECMO support were different.…”

Patient Selection and Timing of Continuous Renal Replacement Therapy

“…Previous studies in patients treated with VA and VV ECMO demonstrated that the incidence of AKI exceeded 70% of whom around 50% needed RRT [54,55] . RRT can be provided by introducing the filter into the ECMO circuit (integrated system) or through separate venous access independent of the ECMO circuit (parallel system).…”

Outcomes among Patients Treated with Renal Replacement Therapy during Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study

“…In 4 small, single-center studies looking at adult patients with AKI requiring combined therapy, the mortality rates were 60,78, 80, and 100%, respectively [5,7,10,11]. In a larger, more recent single-center study; 63 among 135 patients required combined ECMO and CRRT; however, mortality rates were similar among groups receiving ECMO without AKI, ECMO with AKI, and ECMO with AKI requiring CRRT [12].…”