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Kidney Week

Abstract: FR-OR07

Determinants of Major Adverse Kidney Events (MAKE) in Extra Corporeal Membrane Oxygenation (ECMO) Survivors

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Bobba, Aniesh, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States
  • Costanian, Christy, Lebanese American University School of Medicine, Byblos, Lebanon
  • Bahous, Sola Aoun, Lebanese American University School of Medicine, Byblos, Lebanon
  • Tohme, Fadi, Washington University in Saint Louis School of Medicine, Saint Louis, United States
Background

The majority of ECMO patients develop acute kidney injury (AKI) and 40-60% require renal replacement therapy (RRT). Little is known about the effects of AKI on long-term renal outcomes after ECMO. The aim of this study was to examine the determinants of MAKE in ECMO survivors.

Methods

Patients who were admitted to a single-center between 2008 and 2017, were on ECMO for more than 24 hours & survived to hospital discharge were included. MAKE was defined as either doubling of serum creatinine (Scr), incident ESRD or death. USRDS and NDI databases were used to obtain information about ESRD and death. AKI was defined as KDIGO stages 2-3. Complete AKI recovery was defined as a return to 50% of baseline Scr and partial recovery as an improvement in the AKI stage without a return to 50% of baseline Scr. Survival analysis plots & Cox regression models were fitted to examine the associations of AKI status, AKI recovery and other factors with MAKE

Results

Among 188 ECMO patients who survived until hospital discharge, 63% had AKI, and 41% required RRT. The mean follow-up time was 3.4 years. Patients with AKI were more likely to be on ECMO for a cardiac rather than respiratory indication and had a longer length of stay compared to patients with no AKI. Kaplan-Meier survival curves showed that patients with no/partial recovery from AKI had a higher rate of MAKE compared to those with no AKI (Figure 1). Results of the unadjusted analysis showed that ECMO type and timing of initiation of RRT were associated with MAKE. Multivariate analysis showed that AKI [aHR=1.79 (95%CI=1.00-3.21)], no/partial recovery from AKI [aHR= 2.94 (95%CI=1.46-5.92)] and initiation of RRT after ECMO [aHR 5.4 (95%CI=1.14-25.6)] were significant determinants of MAKE after adjustment for potential confounders.

Conclusion

AKI, AKI recovery status, and timing of initiation of RRT are determinants of major adverse kidney events in patients who received ECMO.