Long‐term renal function after venoarterial extracorporeal membrane oxygenation

Abstract

Background The utilization of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) as a life‐supporting therapy has increased exponentially over the last decade. As more patients receive and survive ECMO, there are a number of unanswered clinical questions about their long‐term prognosis and organ function including the need for long‐term dialysis. Methods We aimed to utilize over 208 patient‐years of follow‐up data from our large institutional cohort of VA‐ECMO patients to determine the incidence of requiring VA‐ECMO support on the need for renal replacement therapy after discharge (LT‐dialysis). This retrospective review included all adult VA‐ECMO patients at our institution from January 2014 to October 2018 (N = 283). Results Out of the 99 (35%) survivors, 88 (89%) did not require LT‐dialysis of any duration after discharge from the index hospitalization. Patients who required VA‐ECMO for decompensated cardiogenic shock were more likely to need LT‐dialysis (p = .034), and those who required renal replacement therapy during VA‐ECMO (N = 27) also had a higher incidence of LT‐dialysis (33%). Conclusion Overall, these data suggest there is a low incidence of long‐term dialysis dependence among survivors of VA‐ECMO support. Worries about the potential long‐term detrimental effect of VA‐ECMO should not preclude patients from receiving this life‐saving support.

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.…”

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

“…Two large cohort studies from the Taiwan’s National Health Insurance Research Database including VV- and VA-ECMO patients revealed increased risks of CKD, ESKD, and all-cause mortality in AKI-RRT patients (mean follow-up 2.4 ± 2.5 years per patient) [ 10 , 28 ]. A study in VA-ECMO patients demonstrated 11% dialysis dependence (median follow-up 64 months in non-ESKD patients) and 51% prevalence of CKD at 1 year [ 29 ]. Another recent study of predominantly VA-ECMO survivors (80%) reported major adverse kidney events (median follow-up time 3.4 years) which include AKI, partial/no recovery at discharge, and RRT on the same date or after ECMO initiation [ 30 ].…”

Letter To The Editor: Long-Term Renal Function After Venoarterial Extracorporeal Membrane Oxygenation.

“…To the Editor, We recently reviewed the article "Long-term renal function after venoarterial extracorporeal membrane oxygenation" by Brian ayers MD et al 1 with deep interest. The article is well written, and the author's work is cherished and appreciated regarding this valuable topic.…”