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Abstract: FR-PO109

Intravascular Hemolysis and AKI in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO)

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Strong, Amy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Zee, Jarcy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Fulchiero, Rosanna, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Campos, Diego, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Kilbaugh, Todd J., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Laskin, Benjamin L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Background

AKI is common in ECMO patients. We sought to describe the impact of laboratory evidence of ECMO associated intravascular hemolysis on AKI.

Methods

This retrospective cohort study included patients treated with ECMO at a single center over ten years. The primary outcome was a composite of time to renal replacement therapy (RRT) or AKI (by creatinine based KDIGO criteria) after ECMO start. Serum creatinine closest to ECMO start time was considered the pre-ECMO baseline and used to determine abnormal kidney function at ECMO start. The patient’s subsequent creatinine values were used to identify AKI on ECMO. Multivariable cause-specific cox proportional hazards models were used to assess the impact of markers of intravascular hemolysis on time to the composite outcome after controlling for confounders.

Results

501 children were evaluated: median age 1.2 years, 56% male. Four models are presented in Table 1 each with a different marker of hemolysis (plasma free hemoglobin, LDH, minimum platelets and minimum hemoglobin). An elevated plasma free hemoglobin level, the most specific of these hemolysis markers, demonstrated a >3-fold higher hazard for the composite outcome (p-value 0.001). Elevated LDH was associated with an adjusted hazard ratio of 2.4. Effect estimates were more pronounced in a sensitivity analysis of stage 2+ AKI/RRT : HR 6.5 (95% CI 3.3-12.8) for plasma free hemoglobin and 3.3 (95% CI 1.7-6.5) for LDH.

Conclusion

Laboratory findings consistent with intravascular hemolysis on ECMO were associated with a higher hazard of AKI or RRT in children undergoing ECMO.

Table 1: Cause-specific cox proportional hazards model for composite of all stages AKI or RRT

Funding

  • NIDDK Support