EARLY CONTINUOUS RENAL REPLACEMENT THERAPY FOR VOLUME MANAGEMENT WITHOUT SIGNIFICANT KIDNEY INJURY DURING EXTRACORPOREAL MEMBRANE OXYGENATION

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Volume overload is linked to higher mortality in extracorporeal membrane oxygenation (ECMO) patients. Correspondingly, early and aggressive volume management has been associated with improved survival. Data on continuous renal replacement therapy (CRRT) specifically for volume removal in the adult ECMO population is deficient. The purpose of this study was to evaluate the efficacy of early CRRT primarily for volume removal in ECMO patients with mild or no kidney injury. METHODS: A single center, retrospective chart review was conducted for ECMO patients over a 9-year period. ECMO patients with mild or no kidney injury who received CRRT for volume removal were compared to like patients who did not receive CRRT. Intergroup statistical comparisons were performed using Wilcoxon/Kruskal-Wallis and chi-square tests. RESULTS: 140 ECMO patient charts were reviewed. 74 patients received CRRT. Of these, 19 patients had no or stage 1 acute kidney injury as defined by Kidney Disease Improving Global Outcomes (KDIGO). For comparison, 19 non-CRRT patients were propensity matched for age, gender, and ECMO mode. We reviewed multiple variables with the primary focus being fluid balance at 72-hours post CRRT initiation and survival at discharge. We found a significant difference in fluid balance in the two cohorts. The CRRT group had an average fluid balance of -3840 ml while the non-CRRT group had a net balance of 425 ml for a similar period. CONCLUSIONS: The use of early CRRT for volume management in ECMO patients with minimal or no kidney injury achieved a negative fluid balance that was substantially negative and significantly lower than patients without CRRT. CLINICAL IMPLICATIONS: Aggressive fluid management is a vital aspect of ECMO care. Our findings suggest that early CRRT in ECMO patients without significant kidney injury can achieve a considerable negative fluid balance. DISCLOSURES: No relevant relationships by Jason Thomas, source=Web Response