Long-term outcomes in patients who received veno-venous extracorporeal membrane oxygenation and renal replacement therapy: a retrospective cohort study

Abstract

Background Acute kidney injury (AKI) is a frequent complication in patients with severe respiratory failure receiving extracorporeal membrane oxygenation (ECMO). However, little is known of long-term kidney function in ECMO survivors. We aimed to assess the long-term mortality and kidney outcomes in adult patients treated with veno-venous ECMO (VV-ECMO). Methods This was a single-centre retrospective study of adult patients (≥ 18 years old) who were treated with VV-ECMO at a commissioned ECMO centre in the UK between 1st September 2010, and 30th November 2016. AKI was defined and staged using the serum creatinine and urine output criteria of the Kidney Diseases: Improving Global Outcomes (KDIGO) classification. The primary outcome was 1-year mortality. Secondary outcomes were long-term mortality (up to March 2020), 1-year incidence of end-stage kidney disease (ESKD) or chronic kidney disease (CKD) among AKI patients who received renal replacement therapy (AKI-RRT), AKI patients who did not receive RRT (AKI-no RRT) and patients without AKI (non-AKI). Results A total of 300 patients [57% male; median age 44.5; interquartile range (IQR) 34–54] were included in the final analysis. Past medical histories included diabetes (12%), hypertension (17%), and CKD (2.3%). The main cause of severe respiratory failure was pulmonary infection (72%). AKI occurred in 230 patients (76.7%) and 59.3% received renal replacement therapy (RRT). One-year mortality was 32% in AKI-RRT patients vs. 21.4% in non-AKI patients (p = 0.014). The median follow-up time was 4.35 years. Patients who received RRT had a higher risk of 1-year mortality than those who did not receive RRT (adjusted HR 1.80, 95% CI 1.06, 3.06; p = 0.029). ESKD occurred in 3 patients, all of whom were in the AKI-RRT group. At 1-year, 41.2% of survivors had serum creatinine results available. Among these, CKD was prevalent in 33.3% of AKI-RRT patients vs. 4.3% in non-AKI patients (p = 0.004). Conclusions VV-EMCO patients with AKI-RRT had high long-term mortality. Monitoring of kidney function after hospital discharge was poor. In patients with follow-up creatinine results available, the CKD prevalence was high at 1 year, especially in AKI-RRT patients. More awareness about this serious long-term complication and appropriate follow-up interventions are required.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Categories delineating race or ethnicity varied markedly. Overall, 54 studies (58%) found no statistical association between race and/or ethnicity and outcome (37–76), while 36 (39%) observed adverse outcomes in populations from underrepresented/diverse racial or ethnic backgrounds (Black/African American, Asian, Hispanic, or “other”/“non-Caucasian”/“non-White”). Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses.…”

Recovery Dynamics and Prognosis After Dialysis for Acute Kidney Injury

“…The discrepancy in AKD stages not aligning with long-term outcomes can be attributed to the limitations of SCr as an acute illness kidney function marker. Haines et al 33 and Lumlertgul et al 34 have indicated that SCr values in the initial 3 to 6 months after discharge may not be as trustworthy. This unreliability is possibly due to the impact of acute skeletal muscle wasting on SCr, which may lead to kidney function overestimation.…”

Assessment of Nutritional Risk Scores (the Nutritional Risk Screening 2002 and Modified Nutrition Risk in Critically Ill Scores) as Predictors of Mortality in Critically Ill Patients on Extracorporeal Membrane Oxygenation

“…The identification of malnutrition is made by clinical observation or complementary testing. 28 The overall rate of receiving renal replacement therapy is 40-60% in ECMO patients, 29,30 however clinical practice fluctuates, and there is a strong correlation between mortality and renal replacement therapy as well as the mNUTRIC score. 18,31 In our study, we also found that the number of patients who received CRRT and the mNUTRIC score were significantly increased in the nonsurvival group compared to the survival group.…”