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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.