INCIDENCE AND IMPACT OF ACUTE KIDNEY INJURY IN PATIENTS RECEIVING EXTRACORPOREAL MEMBRANE OXYGENATION: A META-ANALYSIS

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SESSION TITLE: Tuesday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: 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. The study's aim was to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. METHODS: A literature search was performed using MEDLINE, EMBASE and Cochrane Database from inception until December 2018 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, generic inverse variance approach of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). RESULTS: 39 cohort studies with a total of 6,939 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: 40.5%-49.5%), respectively. Meta-regression showed that year of study did not significantly affect the incidence of AKI (p=0.67) or AKI requiring RRT (p=0.76). The pooled OR of hospital mortality among patients receiving ECMO with AKI on RRT was 3.78 (95% CI, 2.77-5.18). 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 3.14 (95% CI, 1.75-5.61). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.99 for the incidence of AKI and severe AKI requiring RRT, respectively. CONCLUSIONS: Among patients receiving ECMO, the overall estimated incidence rates of AKI and severe AKI requiring RRT are high at 62.8% and 44.9%, respectively. The incidence does not seem to change over time. Patients who develop AKI requiring RRT while on ECMO carry 3.14-fold higher hospital mortality. CLINICAL IMPLICATIONS: AKI is common in patients receiving ECMO and is also associated with higher hospital mortality. DISCLOSURES: No relevant relationships by Wisit Cheungpasitporn, source=Web Response No relevant relationships by Kianoush Kashani, source=Web Response No relevant relationships by Ploypin Lertjitbanjong, source=Web Response No relevant relationships by Michael Mao, source=Web Response No relevant relationships by Charat Thongprayoon, source=Web Response