ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2021 and some content may be unavailable. To unlock all content for 2021, please visit the archives.

Abstract: PO0068

Characteristics and Outcomes of Patients with COVID-19 Infection Requiring Extracorporeal Membrane Oxygenator with and Without Continuous Renal Replacement Therapy: A Single-Center Study

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Sekhon, Dilraj S., University of Cincinnati, Cincinnati, Ohio, United States
  • Baker, Richard, University of Cincinnati, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
  • Gudsoorkar, Prakash Shashikant, University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Up to 1-in-3 cases of severe COVID-19 infection can cause respiratory failure sometimes necessitating extracorporeal membrane oxygenation (ECMO) support. Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is a common complication, yet risk factors & outcomes in these patients are not well studied.

Methods

A retrospective single-center study included 40 patients who received ECMO support for severe COVID-19 infection from Jan 20 to April 21. We extracted demographic, clinical, & laboratory variables on all patients. Primary outcome was hospital mortality; other recorded outcomes were total length of stay, ventilator, ECMO, & CRRT days, dialysis dependence at discharge. Group comparisons with & without CRRT were made by 2-sample Wilcoxon test for continuous variables & Fisher’s exact test for categorical variables. Association of CRRT use & primary outcome was assessed by multivariable logistic regression (odds ratio (OR), 95% confidence interval (CI)).

Results

Overall cohort was 62.5% male, 32.5% black, with a median age of 51 years & BMI of 39.4. Thirty percent were diabetic & 42.5% were hypertensive. Of the 40 ECMO patients, 36 were on veno-venous, 2 on arterio-venous, & 2 utilized both veno- and arterio-venous circuits. 19/40 (47.5%) of ECMO patients required CRRT for AKI (3/19 patients CRRT was connected through the ECMO circuit). The median CRRT days were 20. Compared to those without CRRT, ECMO with CRRT patients needed a median of 19 ventilation days vs15, 19 ECMO days vs 11, & 28 hospital days vs 32. Overall mortality was 50% (68.4% ECMO+CRRT vs 33.3% in others; p-value 0.0562). Logistic regression indicated that CRRT use in ECMO was associated with increased adjusted odds of death (6.37 OR, 1.12-36.19 95% CI). Of those who did not experience hospital mortality in the ECMO+CRRT group, 83% were dialysis-dependent at discharge.

Conclusion

Overall, extracorporeal support offers a meaningful bridge until organ recovery in severe COVID-19 infection. Despite necessitating ECMO, 50% of patients were able to be liberated from ECMO & survived. However once renal failure ensued, all patients required CRRT, which in turn predicted poor outcomes.