Abstract: SA-PO089

AKI Requiring Dialysis in ECMO

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Pinal, Cristina E., Baylor Scott&White, Temple, Texas, United States
  • Syed Ahmed, Maaz, Baylor Scott&White, Temple, Texas, United States
  • Concepcion, Luis A., Baylor Scott&White, Temple, Texas, United States
Background

ECMO is used in critically ill patients with life threatening acute respiratory or circulatory failure. AKI requiring dialysis (RRT) is a frequent complication. Purpose: single center retrospective study to determine the incidence of AKI requiring dialysis, the outcome and survival in patients requiring ECMO .

Methods

Adult patients requiring ECMO (2012-1015) included. Demographic, laboratory and dialysis data obtained from the EMR.ECMO in VA/VV configuration by standard methods. Dialysis performed placing a dialyzer(Sorin SH14) in line w/ ECMO circuit and running dialysate (Nxstagetm bicarbonate based) ,using IV pumps 2 L per hour x 24 h a day,Ultrafiltation controlled with IV pump. No heparin used other than for the ECMO circuit.Results as mean and standard deviation, statistical analysis done w/ SPSS version 13.

Results

169 patients, age 53(15) y, weight 92.7 (22) kg, BMI 31(6)EF 49(15)%. 77% white,10%AA,28%DM,61%HTN 13%CKD, 41%CHD, 39% sepsis,82% anemia(Hb<13). ECMO type:52% VA 48%VV.AKI requiring dialysis occur in 89(52.4%). Overall mortality 53%(64%VA 42%VV ECMO).The patients that required RRT had 51.7%mortality vs 54.4% not requiring RRT.Indications for RRT:75%fluid overload,7.7%hyperkalemia, 3.6%acidosis.Within 4 days of admission 69.3%were on ECMO.Within 4 days in ECMO 60.7%of the patient with AKI required RRT.53%of the dialysis treatments done w/ 3K bath,31% 2K, 11% 4K .The mean time on dialysis was 15.7 days(23).52.1% required 8 d of RRT and 75% required 22days of RRT.The patients had 6.7(7)liters of positive fluid balance at the start of RRT.The UF per day was 1.1(1.7)L with 75% of the patients the average daily UF was 2.3L.Serum creatinine at the start of ECMO was 1.57(1.1), at the start of RRT 2.94(1.3)mg/dl.BUN at the start of RRT was 67(37) mg/dl. The number of pressors in RRT 2.9 (1.2) vs 2.6(1.1) in non RRT patients(p<0.05).By Kaplan-Meier analysis the median survival was 31 days(all population),No difference between VA and VV ECMO. For RRT the median survival was 41.6days,not RRT 45 days (NS) by log rank.No difference by diabetic status in survival.

Conclusion

AKI requiring dialysis is a frequent event in patients requiring ECMO.On line dialysis can be performed without the need of a dialysis machine.The mortality was not influence by the need of dialysis support in this critically ill patients.More pressors were needed in the patients that required dialysis support.

Funding

  • Private Foundation Support