Abstract
ObjectiveTo describe acute kidney injury (AKI) natural history and to identify predictors of major adverse kidney events (MAKE) within 1 year in patients supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO).DesignRetrospective observational study.SettingMedical French intensive care unit between January 2014 and December 2016.PatientsConsecutive patients implanted with VA-ECMO ≥ 16 years, VA-ECMO for at least ≥ 48 h, and without end-stage chronic kidney disease (CKD).InterventionNone.MeasurementsMultivariate logistic regression of factors associated with MAKE at 1 year defined as one of the following criteria within day 360: death and receipt of renal replacement therapy (RRT) or persistent renal dysfunction, i.e., CKD ≥ stage 3 corresponding to an estimated glomerular filtration rate (eGFR) ≤ 60 ml/min/1.73 m2 and MAKE at day 30 and day 90 defined as one of the following criteria within day 30 or day 90: death, receipt of renal replacement therapy and serum creatinine ≥ threefold increase.Main results158 consecutive patients were included (male sex: 75.9%; median and interquartile range: age: 59 [47–66], Simplified Acute Physiology Score II: 55 [39–66], Sepsis-related Organ Failure Assessment Score: 9 [7–12], time on VA-ECMO: 7.5 [4–12] days). Among them 145 (91.8%) developed an AKI during the intensive care unit (ICU) stay and 85 (53.8%) needed renal replacement therapy (RRT). 59.9% (91/152), 60.5% (89/147) and 85.1% (120/141) evaluable patients had a MAKE-30, MAKE-90 and MAKE-360, respectively. Factors significantly associated with MAKE-360 were eGFR at baseline (odds ratio (OR) 0.98, confidence interval 95% (CI) [0.97;1.00], p 0.02), Kidney Disease Improving Global Outcome (KDIGO) stage at cannulation (p = 0.03), e.g., stage 3 vs. reference stage 0 OR 10.20 [1.77–58.87], and number of red blood cell (RBC) packs received while under ECMO (OR 1.14, CI 95% [1.01;1.28], p = 0.03). At 1 year among the 51 survivors, almost half of the alive patients (n = 20/51) had a decline of estimated glomerular filtration (eGFR) > 30% mL/min/1.73 m2. Their median eGFR decline was − 26.3% [− 46.6;− 10.7].ConclusionPatients undergoing VA-ECMO had a high risk of AKI during the ICU stay. Factors associated with MAKE 360 were mainly eGFR at baseline, KDIGO stage at cannulation and, number of RBC packs received while under ECMO. Among survivors at 1 year, almost half of the alive patients (n = 20/51) had a decline eGFR > 30%.
Highlights
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a technique to provide circulatory assistance for patients suffering from cardiogenic shock [1]
Factors significantly associated with major adverse kid‐ ney events (MAKE)-360 were estimated glomerular filtration (eGFR) at baseline (odds ratio (OR) 0.98, confidence interval 95% (CI) [0.97;1.00], p 0.02), Kidney Disease Improv‐ ing Global Outcome (KDIGO) stage at cannulation (p = 0.03), e.g., stage 3 vs. reference stage 0 OR 10.20 [1.77–58.87], and number of red blood cell (RBC) packs received while under ECMO
Patients undergoing VA-ECMO had a high risk of Acute kidney injury (AKI) during the intensive care unit (ICU) stay
Summary
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a technique to provide circulatory assistance for patients suffering from cardiogenic shock [1]. Acute kidney injury (AKI) is a common and major complication directly attributable to any extracorporeal device [2]. Various mechanisms are proposed to explain AKI in patients supported with a VA-ECMO such as underlying disease (cardiogenic shock, cardio-renal syndrome), ischemia/reperfusion, systemic inflammatory response syndrome, fluid overload, hypercoagulable state, and hemolysis. Acute and long-term outcomes of AKI occurring in intensive care unit (ICU) are well-described. AKI is associated with early and late mortality rising with AKI severity [3,4,5]. AKI is associated with a long-term risk of chronic kidney disease (CKD) [6, 7]
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