Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Abstract

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

“…Those needs that are classified as unmet require provision of some ample spaces for the purpose of imagination in relation to leveraging the strength associated with big data, as well as relevant artificial intelligence (AI) to improve the overall status of patients with kidney diseases [25]. In this article, we discuss the big data concepts in nephrology, describe the potential use of AI in nephrology and transplantation, and also encourage researchers and clinicians to submit their invaluable research, including original clinical research studies [26][27][28][29][30], database studies from registries [31][32][33], meta-analyses [34][35][36][37][38][39][40][41][42][43][44], and artificial intelligence research [25,[45][46][47][48] in nephrology and transplantation. Table 1 demonstrates known and commonly used databases that have provided big data in nephrology and transplantation [49][50][51].…”

Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis

“…A recent meta-analysis has demonstrated that the pooled incidence of AKI and severe AKI requiring renal replacement therapy (RRT) among adult patients on ECMO was 63% and 45%, respectively. Furthermore, adult ECMO patients with AKI requiring RRT have a significantly increased mortality with a pooled odds ratio (OR) of 3.73 [11]. Although the incidence and associated mortality of AKI in adults on ECMO are widely reported, comparable data in the pediatric population are limited.…”

Fluid Overload and Mortality in Patients with Severe Acute Kidney Injury and Extracorporeal Membrane Oxygenation

“…[1][2][3] Acute kidney injury (AKI) is a frequent complication of critically ill patients receiving ECMO with the mechanism of injury often being multi-factorial (hemodynamic instability, inflammatory response to the membrane, related to the underlying disease process or pre-morbid conditions). [4][5][6][7] The incidence of AKI in the setting of ECMO is highly variable and depends on the AKI definition employed and indications for ECMO; similarly, a significant number of these patients require renal replacement therapy with rates varying from 25.5% to 67% depending on the cohort. [7][8][9][10][11][12] Kashani and colleagues have recently undertaken a meta-analysis of 41 cohort studies including more than 10,000 patients treated with ECMO; they demonstrated that the incidence rate of AKI remains high (pooled estimate incidence (95% CI) 62.8% (52.1%-72.4%) but has not changed over time.…”

“…[4][5][6][7] The incidence of AKI in the setting of ECMO is highly variable and depends on the AKI definition employed and indications for ECMO; similarly, a significant number of these patients require renal replacement therapy with rates varying from 25.5% to 67% depending on the cohort. [7][8][9][10][11][12] Kashani and colleagues have recently undertaken a meta-analysis of 41 cohort studies including more than 10,000 patients treated with ECMO; they demonstrated that the incidence rate of AKI remains high (pooled estimate incidence (95% CI) 62.8% (52.1%-72.4%) but has not changed over time. Further, they demonstrated that in an adjusted analysis, patients with AKI requiring RRT (AKI-D) had an adjusted pooled odds ratio (95% CI) of 3.32 (2.21-4.99); I 2 =82% for inpatient mortality compared to those on ECMO who did not require RRT.…”

“…Further, they demonstrated that in an adjusted analysis, patients with AKI requiring RRT (AKI-D) had an adjusted pooled odds ratio (95% CI) of 3.32 (2.21-4.99); I 2 =82% for inpatient mortality compared to those on ECMO who did not require RRT. 7 Despite the growing literature, factors that determine increased mortality among patients with severe AKI and AKI-D on ECMO require further exploration. The impact of volume overload on general AKI populations and on pediatric patients treated with ECMO has been described.…”