Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation

Askenazi, David; Ambalavanan, Namasivayam; Hamilton, Kiya; Cutter, Gary; Laney, Debbie; Kaslow, Richard A.; Georgeson, Keith E.; Barnhart, Douglas C.; Dimmitt, Reed A.

doi:10.1097/pcc.0b013e3181d8e348

Cited by 151 publications

(135 citation statements)

References 12 publications

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“…The following variables were chosen: calendar year in which ECMO was delivered (15,23); patient age (23)(24)(25); primary diagnosis (23)(24)(25)(26)(27); ECMO support type (16,27); presence of pre-ECMO acute renal failure (23,26,27); presence of comorbid conditions (23,28); pre-ECMO cardiac arrest (25,29); and pre-ECMO measures including duration of mechanical ventilation (23,25,30), arterial blood pH (23,27,31), Pa CO 2 (25), and the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PF ratio) (1,23). In neonatal patients, case-mix was also adjusted for gestational age (24) and birth weight (24).…”

Section: Selection Of Variables and Risk Adjustmentmentioning

confidence: 99%

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Barbaro¹,

Odetola²,

Kidwell³

et al. 2015

Am J Respir Crit Care Med

576

400

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Rationale: Recent pediatric studies suggest a survival benefit exists for higher-volume extracorporeal membrane oxygenation (ECMO) centers.Objectives: To determine if higher annual ECMO patient volume is associated with lower case-mix-adjusted hospital mortality rate. Methods:We retrospectively analyzed an international registry of ECMO support from 1989 to 2013. Patients were separated into three age groups: neonatal (0-28 d), pediatric (29 d to ,18 yr), and adult (>18 yr). The measure of hospital ECMO volume was age group-specific and adjusted for patient-level case-mix and hospitallevel variance using multivariable hierarchical logistic regression modeling. The primary outcome was death before hospital discharge. A subgroup analysis was conducted for 2008-2013.Measurements and Main Results: From 1989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Annual ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pediatric cases. In 2008-2013, the volume-outcome association remained statistically significant only among adults. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases.Conclusions: In this international, case-mix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-2013 for neonates and adults; the association among adults persisted in 2008-2013.

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Section: Selection Of Variables and Risk Adjustmentmentioning

confidence: 99%

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Barbaro¹,

Odetola²,

Kidwell³

et al. 2015

Am J Respir Crit Care Med

576

400

View full text Add to dashboard Cite

show abstract

“…As in critically ill patients who have not used ECMO supportive therapy, AKI and fluid overload are also associated with worse outcomes for patients on ECMO [9,10]. Despite the importance of managing these conditions in these individuals, the procedural recommendations are based solely on isolated data from centers that have experience in managing these patients.…”

Section: Acute Kidney Injury and Ecmomentioning

confidence: 99%

Interaction between Renal Replacement Therapy and Extracorporeal Membrane Oxygenation Support

Romano¹

2013

Surgery Curr Res

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“…Moreover, AKI is an independent risk factor for prolonged mechanical ventilation and pediatric ICU mortality (1,4). Recently, our group and other research groups reported high incidences of AKI in children treated with extracorporeal membrane oxygenation (ECMO), who tend to be the most critically ill admitted to an ICU (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

Zwiers¹,

IJsselstijn²,

Rosmalen³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term follow-up of children and adolescents previously treated with neonatal extracorporeal membrane oxygenation were determined.Design, setting, participants, & measurements Between November of 2010 and February of 2014, neonatal survivors of extracorporeal membrane oxygenation who visited the prospective follow-up program at 1, 2, 5, 8, 12, and 18 years of age were screened for CKD and hypertension (BP$95th percentile of reference values). CKD was suspected in children with either an eGFR,90 ml/min per 1.73 m 2 or proteinuria (urinary protein-tocreatinine ratio .0.50 for children ages #24 months and .0.20 at .24 months). The RIFLE classification (risk, injury, or failure as 150%, 200%, or 300% of serum creatinine reference values) was used to define AKI during extracorporeal membrane oxygenation without preemptive hemofiltration.Results Median follow-up of 169 screened participants was 8.2 years (interquartile range=5.2-12.1 years). Nine children had a lower eGFR, but all rates were .60 ml/min per 1.73 m 2 . Proteinuria was observed in 20 children (median=0.26 mg protein/mg creatinine; interquartile range=0.23-0.32 mg protein/mg creatinine), and 32 children had hypertension. Only history of AKI was associated with CKD (P=0.004). Children with RIFLE scores injury and failure had 4.3 times higher odds of CKD signs or hypertension than those without AKI (95% confidence interval, 1.6 to 12.1; P=0.004).Conclusions Altogether, 54 participants (32%) had at least one sign of CKD and/or hypertension. However, most values were marginally abnormal, with no immediate consequences for clinical care. Nevertheless, a prevalence of 32% clearly indicates that survivors of neonatal extracorporeal membrane oxygenation, especially those with AKI, are at risk of a more rapid decline of kidney function with increasing age. Therefore, screening for CKD development in adulthood is recommended.

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Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation

Cited by 151 publications

References 12 publications

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Interaction between Renal Replacement Therapy and Extracorporeal Membrane Oxygenation Support

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

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