Long-term outcomes after extracorporeal membrane oxygenation in patients with dialysis-requiring acute kidney injury: A cohort study

Chen, Shaowei; Lu, Yueh-An; Lee, Cheng‐Chia; Chou, An‐Hsun; Wu, Victor Chien‐Chia; Chang, Su-Wei; Fan, Pei‐Chun; Tian, Ya-Chung; Tsai, Feng‐Chun; Chang, Chih Han

doi:10.1371/journal.pone.0212352

Cited by 35 publications

(31 citation statements)

References 41 publications

(40 reference statements)

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“…This is not surprising, because AKI, particularly in patients who require dialysis therapy, is an independent risk factor of death for patients receiving ECMO [8]. Chen et al found that the outcomes were worse in ECMO patients who had dialysis requiring AKI than in those with AKI not requiring dialysis [14]. Furthermore, Antonucci et al reported that the use of CRRT was not associated with increased mortality in patients who received ECMO support [15].…”

Section: Discussionmentioning

confidence: 99%

Analysis of survival after initiation of continuous renal replacement therapy in patients with extracorporeal membrane oxygenation

et al. 2019

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Background No study has specifically investigated the duration of continuous renal replacement therapy (CRRT) in patients who experienced acute kidney injury during extracorporeal membrane oxygenation (ECMO) support. However, there are concerns that prolonged CRRT may be futile. Methods We conducted a retrospective population-based cohort study using Taiwan National Health Insurance Research Database data collected between January 1, 2007 and December 31, 2013. Patients who received ECMO and CRRT during the study period were included. We divided patients into three groups based on the duration of CRRT received: ≤ 3 days, 4–6 days, and ≥ 7 days. The outcomes were all-cause mortality, end-stage renal disease, ventilator dependency, and readmission rate. Results There were 247, 134 and 187 patients who survived the hospitalization in the CRRT for ≤3 days, 4–6 days and > 7 days respectively. Survival after discharge did not differ significantly between CRRT for 4–6 days vs. ≤ 3 days (adjusted hazard ratio [aHR] 1.16, 95% confidence interval [CI] 0.85–1.57), between CRRT for > 7 days vs. ≤ 3 days (aHR 1.001, 95% CI 0.73–1.38) and between CRRT for > 7 days vs. 4–6 days (aHR 0.87, 95% CI 0.62–1.22). The patients who received CRRT for ≥7 days had a higher risk of ESRD than did those who received CRRT for ≤3 days (adjusted hazard ratio [aHR] 3.46, 95% confidence interval [CI] 1.47–8.14) and for 4–6 days (aHR 3.10, 95% CI 1.03–9.29). The incidence of ventilator dependence was higher in the patients with CRRT ≥7 days than in those with ≤3 days (aHR 2.45, 95% CI 1.32–4.54). The CRRT ≥7 days group also exhibited a higher readmission rate than did the 4–6 days and ≤ 3 days groups (aHR 1.43, 95% CI 1.04–1.96 and aHR 1.67, 95% CI 1.13–2.47, respectively). Conclusions Our study found similar long-term survival but increased ESRD and ventilator dependency among ECMO patients who underwent CRRT for ≥7 days. These results offer reason to be concerned that this aggressive life support may maintain patient survival but do so at the cost of long-term disabilities and a lower quality of life. Electronic supplementary material The online version of this article (10.1186/s12882-019-1516-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Analysis of survival after initiation of continuous renal replacement therapy in patients with extracorporeal membrane oxygenation

et al. 2019

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“…In total, 25 studies detailing 5896 adult patients that reported on the use of RRT and ECMO were included ( Table 1 ) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Twenty-four studies were observational in nature [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], while one study was a randomised controlled trial (RCT) [ 52 ]. For our quantitative analysis, we included 24 observational studies (5855 patients), while the findings of the RCT were reported separately.…”

Section: Resultsmentioning

confidence: 99%

“…The proportion of male patients across the studies ( Figure S3 ) was 68.2% (95% CI: 64.4–71.9%). After removing the two outliers detected by LOO analysis [ 29 , 31 ], the proportion of males was 67.0% (95% CI: 63.0–70.8%). Pooled proportion of concurrent use of VA-ECMO with RRT from 22 studies ( Figure S4 ) was 71.8% (95% CI: 49.8–89.6%) with a significant publication bias ( P egger = 0.007).…”

Section: Resultsmentioning

confidence: 99%

“…The pooled overall mortality ( Figure 1 ) in patients due to the use of RRT on ECMO (24 studies) was 62.9% (95% CI: 56.0–69.6%). Subgroup analysis found no significant differences ( p = 0.57) between in-hospital mortality (14 studies, 60.1%, 95% CI: 50.1–69.8%) [ 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 42 , 43 , 45 , 48 , 49 , 50 ], ICU mortality (3 studies, 67.3%, 95% CI: 60.1–74.1%) [ 28 , 29 , 32 ], 30-day mortality (3 studies, 68.4%, 95% CI: 58.0–77.9%) [ 41 , 44 , 47 ], and 90-day mortality (3 studies, 57.0%, 95% CI: 17.6–92.0%) [ 30 , 40 , 46 ]. Only one study mentioned overall mortality [ 51 ].…”

Section: Resultsmentioning

confidence: 99%

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Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

Safari

Ling

Tan

et al. 2021

JCM

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Patients supported with extracorporeal membrane oxygenation (ECMO) often receive renal replacement therapy (RRT). We conducted this systematic review and meta-analysis (between January 2000 and September 2020) to assess outcomes in patients who received RRT on ECMO. Random-effects meta-analyses were performed using R 3.6.1 and certainty of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was pooled mortality. The duration of ECMO support and ICU/hospital lengths of stay were also investigated. Meta-regression analyses identified factors associated with mortality. A total of 5896 adult patients (from 24 observational studies and 1 randomised controlled trial) were included in this review. Overall pooled mortality due to concurrent use of RRT while on ECMO from observational studies was 63.0% (95% CI: 56.0–69.6%). In patients receiving RRT, mortality decreased by 20% in the last five years; the mean duration of ECMO support and ICU and hospital lengths of stay were 9.33 days (95% CI: 7.74–10.92), 15.76 days (95% CI: 12.83–18.69) and 28.47 days (95% CI: 22.13–34.81), respectively, with an 81% increased risk of death (RR: 1.81, 95% CI: 1.56–2.08, p < 0.001). RRT on ECMO was associated with higher mortality rates and a longer ICU/hospital stay compared to those without RRT. Future research should focus on minimizing renal dysfunction in ECMO patients and define the optimal timing of RRT initiation.

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“…Based on the indication for ECMO, the modality of ECMO is adapted for the patient. Veno-venous (VV) ECMO provides only respiratory support, and requires patients to have stable hemodynamics, whereas veno-arterial (VA) ECMO provides dual cardiac and respiratory support [1][2][3][4][5][6][7]. In VA ECMO, the blood bypasses both the heart and lungs.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background: Acute kidney injury (AKI) is a well-established complication of extra-corporal membrane oxygenation (ECMO) in the adult population. The data in the pediatric and neonatal population is still limited. Moreover, the mortality risk of AKI among pediatric patients requiring ECMO remains unclear. Thus, this meta-analysis aims to assess the incidence of AKI, AKI requiring renal replacement therapy and AKI associated mortality in pediatric/neonatal patients requiring ECMO. Methods: A literature search was performed utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring renal replacement therapy (RRT) and the risk of mortality among pediatric patients on ECMO with AKI. Random-effects meta-analysis was used to calculate the pooled incidence of AKI and the odds ratios (OR) for mortality. Results: 13 studies with 3523 pediatric patients on ECMO were identified. Pooled incidence of AKI and AKI requiring RRT were 61.9% (95% confidence interval (CI): 39.0–80.4%) and 40.9% (95%CI: 31.2–51.4%), respectively. A meta-analysis limited to studies with standard AKI definitions showed a pooled estimated AKI incidence of 69.2% (95%CI: 59.7–77.3%). Compared with patients without AKI, those with AKI and AKI requiring RRT while on ECMO were associated with increased hospital mortality ORs of 1.70 (95% CI, 1.38–2.10) and 3.64 (95% CI: 2.02–6.55), respectively. Conclusions: The estimated incidence of AKI and severe AKI requiring RRT in pediatric patients receiving ECMO are high at 61.9% and 40.9%, respectively. AKI among pediatric patients on ECMO is significantly associated with reduced patient survival.

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Long-term outcomes after extracorporeal membrane oxygenation in patients with dialysis-requiring acute kidney injury: A cohort study

Cited by 35 publications

References 41 publications

Analysis of survival after initiation of continuous renal replacement therapy in patients with extracorporeal membrane oxygenation

Analysis of survival after initiation of continuous renal replacement therapy in patients with extracorporeal membrane oxygenation

Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

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

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