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Abstract: TH-PO285

Timing of Continuous Renal Replacement Therapy in Critically Ill Patients on Extracorporeal Membrane Oxygenation

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Zhou, Jing, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  • Gu, Yue, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  • Gao, Mei, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  • Shao, Fengmin, Henan Provincial People's Hospital, Zhengzhou, Henan, China
Background

To investigate the timing for continuous renal replacement therapy (CRRT) in critically ill patients undergoing extracorporeal membrane oxygenation (ECMO).

Methods

Clinical data were collected of critically ill patients who received ECMO combined with CRRT in the Intensive Care Unit (ICU) of Henan Provincial People's Hospital from January 2017 to June 2021. According to the time to start CRRT after ECMO application, they were divided into early CRRT group or late CRRT group. The differences in baseline clinical data and mortality between the two groups were compared. Kaplan-Meier curves obtained with the Log-rank test were plotted to demonstrate the differences in patients' survival between the two groups. Cox regression analysis was used to explore the risk factors of death.

Results

A total of 122 patients were enrolled, while 96 patients (78.69%) died. The early CRRT group and late CRRT group included 100 cases (81.97%),22 cases (18.03%),respectively. Compared with the late CRRT group, the early CRRT group had higher proportion of receiving ECMO treatment due to respiratory and cardiac arrest, proportion of ECMO with venous-arterial mode, APACHEII score, and SOFA score (all P<0.05). In contrast, ICU stay time, The mechanical ventilation time and ECMO application time were shorter (all P<0.05). Kaplan-Meier curve showed that there was no significant difference in cumulative survival between the two group (χ2=3.397, P=0.065). Time-Dependent Cox Regression Model showed that Early CRRT was a risk influencing factor for patient death {HR=Exp[3.642+1.177×ln(t)], 95% CI 3.225~451.394, P=0.004}. Multivariate Cox regression analysis showed that early CRRT {HR=Exp[3.499+1.162×ln(t)], 95% CI 2.123~516.029, P=0.013}, ECMO weaning failed (HR=3.470, 95%CI 1.986~6.061, P<0.001), high APACHEII score (HR=1.042, 95% CI 1.001~1.085, P=0.044) were risk factors for in-hospital death.

Conclusion

Early CRRT after ECMO treatment may have a greater effect on mortality in critically ill patients than the late CRRT. Failure of ECMO weaning and high APACHEII score were risk factors for in-hospital death.

Funding

  • Government Support – Non-U.S.