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Kidney Week

Abstract: PO0036

AKI in Extracorporeal Support

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Subramanyam, Santosh, UAB Hospital, Birmingham, Alabama, United States
  • Marshall, Tammy, UAB Hospital, Birmingham, Alabama, United States
  • Gongora, Enrique, UAB Hospital, Birmingham, Alabama, United States
  • Wille, Keith M., UAB Hospital, Birmingham, Alabama, United States
  • Tolwani, Ashita J., UAB Hospital, Birmingham, Alabama, United States
Background

Acute kidney injury (AKI) is common in critically ill patients receiving extracorporeal membrane oxygenation (ECMO). Use of continuous renal replacement therapy (CRRT) with ECMO may help optimize fluid balance and correct electrolyte abnormalities but may also worsen outcomes. The relationship between AKI, CRRT, and survival in ECMO patients remains poorly defined. The aim of this study was to evaluate AKI outcomes in the setting of ECMO support. We assessed factors that may influence AKI severity, as well as the safety of combined CRRT with ECMO

Methods

We performed a retrospective analysis of patients that received ECMO from 2018-2021 at a tertiary hospital, using a prospectively maintained database. All patients requiring CRRT received continuous veno-venous hemodiafiltration (CVVHDF). Data collected includes demographics, ECMO and CRRT parameters, anticoagulation, baseline kidney disease, baseline serum creatinine (sCr), ECMO and CRRT duration, hospital length of stay (LOS), complications (patient and device-related), and outcomes.

Results

To date, 16 ECMO patients with AKI have been analyzed. Mean age was 46.6 +/- 15.6 years. Eleven (68%) were male, and 50% were African American. ECMO indication included respiratory failure due to COVID-19 (43%), followed by respiratory failure from sepsis (19%). Initial ECMO modality was VV- in 75% and VA- in 25%. Mean baseline sCr and sCr at CRRT initiation were 1.3+/-1 mg/dL and 3.93+/-1.1 mg/dL, respectively. Mean ECMO duration was 30+/-37 days, and mean CRRT duration was 26+/–21 days. Elevated plasma hemoglobin (mean peak 103 mg/dL) levels occurred in 14 (88%) patients. Of 10 (63%) patient surviving to discharge, 3 (30%) were dialysis dependent. sCr at CRRT start did not influence CRRT duration: for sCr<4 mg/dL, mean CRRT duration was 37 days, and for sCr>4 mg/dL, mean CRRT duration was 20 days (p=0.21). Mean creatinine at discharge was 1.78+/-1.1 mg/dL.

Conclusion

Our results suggest that CRRT can be safely combined with ECMO to achieve satisfactory patient outcomes. Dialysis independence seems attainable in most patients; however, additional patient enrollment is underway to support this concept with a greater degree of confidence.