Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy

Abstract

Objective

This single center retrospective study aimed to describe the variables associated with outpatient dialysis dependence in extracorporeal membrane oxygenation (ECMO) patients who needed continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) during their hospitalization.

Methods

Retrospective study of patients who required ECMO-CRRT.

Results

Between the years of 2016 and 2022, 202 patients required ECMO-CRRT. One hundred and six patients (52.5%) survived their hospitalization and were followed up for a median of 391 [133, 1005] days. Eighty-one patients (76.5%) recovered kidney function and were dialysis-free before hospital discharge. Twenty-five patients (23.5%) were hemodialysis-dependent after hospitalization. On multivariate regression analysis, hyperlipidemia (odds ratio, OR 6.08 [1.67–22]) and CRRT duration (OR 1.09 [1.03–1.15]) were associated with the need for dialysis post-hospitalization. In this group, 16 patients eventually became dialysis-free, after a median of 49 [34.7, 78.5] days. These patients had a higher median baseline glomerular filtration rate (GFR) compared to those who never recovered renal function (93 mL/min/1.73 m² [82.4, 104.3] vs. 63.8 mL/min/1.73 m² [37.9, 83], p = .009). Their follow-up GFR was lower compared to those who recovered renal function before hospital discharge; (87 mL/min/1.73 m² [68.2, 98.9] vs. 99 mL/min/1.73 m² [79, 118], p = .07).

Conclusions

AKI requiring CRRT was associated with high mortality in patients receiving ECMO. Nonetheless, most ECMO survivors became dialysis-free before hospital discharge. Variables associated with the need for outpatient dialysis included hyperlipidemia and prolonged need for CRRT during hospitalization.

Keywords:

• Chronic kidney disease
• extracorporeal membrane oxygenation
• continuous renal replacement therapy
• dialysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are available in a database from the corresponding author on reasonable request.

Additional information

Funding

None.