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Kidney Week

Abstract: FR-PO029

Outcomes of Patients on Extracorporeal Membrane Oxygenation with AKI Requiring Dialysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Sakhuja, Ankit, West Virginia University, Morgantown, West Virginia, United States
  • Mccarthy, Paul J., West Virginia University, Morgantown, West Virginia, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background

Acute kidney injury (AKI) is a common complication among critically ill patients including those receiving Extracorporeal Membrane Oxygenation (ECMO). Despite increasing application of ECMO and improved outcomes for patients receiving it, little is known about outcomes of AKI requiring dialysis (AKI-D) in these patients. We therefore sought to investigate the epidemiology and outcomes of AKI-D among patients receiving ECMO.

Methods

We utilized data from National (Nationwide) Inpatient Sample from 2007-2014. ECMO and with AKI-D were identified using ICD-9-CM codes. We compared proportions of patients meeting various outcomes use the Chi square test. Our primary outcome was inpatient mortality. We also stratified our analysis by time comparing 2007-2010 and 2011-2014. Finally we conducted multivariable logistic regression adjusting for patient/hospital demographics, co-morbidities, acute organ dysfunction, and cardiac surgery during the index hospitalization to assess the impact of AKI-D on mortality.

Results

Of estimated 16,368 (95% CI: 14,185-18,551) hospitalizations receiving ECMO, 2,266 (13.8%) had AKI-D. The proportion of AKI-D was similar between the two time periods (14.3% vs 13.7%, p=0.8) as was the proportion of those started on dialysis on the same day or after ECMO initiation (64.8% vs 73.6%, p=0.1). Compared to patients without AKI-D, those with AKI-D were more male (67.2% vs 61.2%, p=0.03), less often on Medicare/Medicaid (41.4% vs 53.2%, p=0.02) and admitted more often at larger hospitals (91.5% vs 87.2%, p=0.02). Mortality was significantly higher in those with AKI-D (70.9% vs 54.0%, p<0.001) and did not differ by time period. In multivariate analysis AKI-D was an independent predictor of mortality (OR 1.43; 95% CI: 1.09-1.87).

Conclusion

About 14% of patients on ECMO develop AKI-D with majority started on dialysis on the day of or after ECMO initiation. Though there has been a reduction in mortality, it remains significantly high in patients with AKI-D.