Risk factors of acute kidney injury in adult patients under veno-arterial extracorporeal membrane oxygenation support

Abstract

ObjectiveTo investigate the incidence and risk factors of acute kidney injury (AKI) stage 3 in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. DesignA retrospective case-control study. SettingSingle center, Fuwai hospital. ParticipantsAdult VA-ECMO patients aged 18 years and older, treated from January 2020 to December 2022 were included. InterventionsThe patients were grouped by whether they developed AKI Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 or < 3. Multivariate logistic regression was performed to evaluate risk factors of AKI stage 3. Measurements and main resultsAmong enrolled patients, 40 (53.3%) developed AKI stage 3. The in-hospital mortality of AKI stage 3 patients was significantly higher than that of AKI stage<3 patients (67.5% vs. 34.3%, p = 0.004). Multivariate logistic regression analysis revealed that concomitant hypertension [OR 0.250, 95% CI (0.063, 0.987), p = 0.048), pre-ECMO hemoglobin [OR 0.969, 95% CI (0.947, 0.992), p = 0.009], pre-ECMO lactate [OR 1.173, 95% CI (1.028, 1.339), p = 0.018], and pre-ECMO creatinine [OR 1.014, 95% CI (1.003, 1.025), p = 0.011] were independent risk factors for AKI stage 3. ConclusionThis study found a high incidence (53.3%) of AKI stage 3 in adult patients with VA-ECMO support and was associated with increased in-hospital mortality. Concomitant hypertension, low pre-ECMO hemoglobin, elevated pre-ECMO lactate and pre-ECMO creatinine were independent risk factors for AKI stage 3 in patients receiving VA-ECMO. It is imperative to identify and adjust these risk factors to enhance outcomes for those supported by VA-ECMO.