Abstract
Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.
Highlights
Extracorporeal membrane oxygenation (ECMO), as a mechanical circulatory support system, is utilized as a treatment for cardiovascular or respiratory failure [1,2,3]
Studies were included in this systematic review if they were clinical trials or observational studies that reported the incidence of acute kidney injury (AKI) (using standard AKI definitions including RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) [72], AKIN (Acute Kidney Injury Network) [73], and Kidney Disease Improving Global Outcomes (KDIGO) (Kidney Disease: Improving Global Outcomes) classifications) [74], severe AKI requiring renal replacement therapy (RRT), and mortality risk of AKI among adult patients on extracorporeal membrane oxygenation (ECMO)
Our study demonstrated a higher incidence of AKI among patients requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO) (60.8%) than those requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) (45.7%)
Summary
Extracorporeal membrane oxygenation (ECMO), as a mechanical circulatory support system, is utilized as a treatment for cardiovascular or respiratory failure [1,2,3]. Studies have demonstrated survival benefits of ECMO ranging from 20% to 50% in patients with cardiac arrest, severe adult respiratory distress syndrome (ARDS), and refractory cardiogenic shock [5,10,11,12,13,14,15,16]. Despite these benefits, there have been a number of reports to highlight the concomitant occurrence of organ failures and complications including acute kidney injury (AKI), infections, thrombosis, bleeding and coagulopathy, and neurological events [17,18]. This systematic review was conducted with the aim to summarize the incidence (using standard AKI definitions) and the impact of AKI on mortality risk among adult patients on ECMO
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
