Abstract: SA-PO0684
Plasma Renin as a Predictor of AKI, Mortality, and Severity of Illness in Pediatric Extracorporeal Membrane Oxygenation
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Young, Michael F., Nationwide Children's Hospital, Columbus, Ohio, United States
- Yates, Andrew R., Nationwide Children's Hospital, Columbus, Ohio, United States
- Cortado, Hanna H., Nationwide Children's Hospital, Columbus, Ohio, United States
- Becknell, Brian, Nationwide Children's Hospital, Columbus, Ohio, United States
- Spencer, John David, Nationwide Children's Hospital, Columbus, Ohio, United States
- Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
Background
Extracorporeal membrane oxygenation (ECMO) is used in children with cardiorespiratory failure. Acute kidney injury (AKI) is associated with mortality in children requiring ECMO. Renin has been investigated in adults as a biomarker for AKI and mortality. Renin has not been evaluated as a prognostic biomarker in children requiring ECMO. We hypothesized that elevated plasma renin following initiation of ECMO would predict AKI, mortality, and severity of illness.
Methods
Single center study of pediatric ICU patients requiring ECMO between 2015 and 2024. Patients with CKD or renal replacement therapy (RRT) prior to ECMO were excluded. Plasma renin levels were serially measured with ELISA before, after, and during the first 8 days of ECMO. Diagnosis of AKI was based on KDIGO serum creatinine criteria. Pediatric Sepsis-related Organ Failure Assessment (pSOFA) was used to assess severity of illness.
Results
Cohort included 27 patients between 1 month and 17 years of age. Common ECMO indications were sepsis (67%, n = 18) and cardiac failure (26%, n = 7). Venovenous (VV) ECMO was the most common modality (67%, n = 18) with an average duration of 191 hours. Mortality was 26% (n = 7). 70% of patients required RRT (n = 19) with an average duration of 10 days. Higher plasma renin level at hours 6 (p = 0.013) and 24 (p = 0.027) of ECMO were associated with AKI. Pre-ECMO levels were associated with mortality (p = 0.003). Levels following completion of ECMO were associated with mortality (p = 0.026) and RRT duration (p = 0.007, r2 0.573). Levels at 4 hours were associated with 24h pSOFA (p = 0.047, r2 0.175). Levels at 24 hours were associated with length of stay (LOS) (p = 0.03, r2 0.238). Levels in venoarterial (VA) ECMO were higher than VV during the first 48 hours with significant elevations at hours 2, 4, and 6 (p = 0.02, 0.042, and 0.023, respectively).
Conclusion
Renin increases with ECMO and higher levels within the first 24 hours predict AKI, mortality, and LOS. Most notably, pre-ECMO levels predict mortality, further underlying its role as an early, prognostic biomarker in critically-ill children. Further study with intervention-based studies is needed as the renin-angiotensin-aldosterone system is a modifiable target.