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

Figures & data

Figure 1. Flowchart of the study. *CRRT: continuous renal replacement therapy. Patients with ESRD on HD on admission were excluded.

Table 1. Characteristics of patients on ECMO-CRRT who survived their hospitalization.

	Survived hospitalization, N = 106	Deceased, N = 96	p Value
Age, years, median [IQR]	51.5 [39, 59]	58 [51, 66]	<.0001
Male gender, N (%)	81 (76.4)	64 (66.7)	.15
Diabetes mellitus, N (%)	38 (35.8)	24 (25)	.12
Hypertension, N (%)	75 (70.7)	57 (59.4)	.10
Congestive heart failure, N (%)	21 (19.8)	15 (15.6)	.46
Coronary artery disease, N (%)	25 (23.6)	29 (30.2)	.34
Hyperlipidemia, N (%)	39 (36.8)	33 (34.4)	.76
Atrial fibrillation/flutter, N (%)	10 (9.43)	11 (11.5)	.65
Chronic pulmonary disease, N (%)	34 (32)	25 (26)	.35
Chronic liver disease, N (%)	1 (0.94)	2 (2.1)	.60
GFR on admission, mL/min/1.73 m^2, median [IQR]	79.5 [52.8, 98.7]	69.8 [47.1, 97.5]	.26
Body mass index, kg/m^2, median [IQR]	33.3 [29.1, 41.2]	31 [26.6, 37.2]	.0089
Indications for ECMO
Cardiac, N (%)	29 (27.4)	48 (50)	.0009
Respiratory, N (%)	77 (72.64)	48 (50)
VV-ECMO, N (%)	66 (62.3)	38 (39.6)	.001
VA-ECMO, N (%)	19 (17.9)	38 (39.6)
VVV, VVA, VAV-ECMO, N (%)	21 (19.8)	20 (20.8)
Days on ECMO, median [IQR]	7.71 [5, 13]	7.47 [3, 17]	.76
Days on CRRT, median [IQR]	8 [5, 15]	7 [3, 17]	.35
Hours on CRRT, median [IQR]	192 [114, 342]	168 [72, 408]	.41
Fluid balance, mL, median [IQR]	−4670 [−14,127, 7471]	7339 [−155, 16,048]	<.0001
Pressor requirement, N (%)	106 (100)	96 (100)	1
Number of pressors, median [IQR]	4 [3, 5]	4 [3, 5]	.94

ECMO: extracorporeal membrane oxygenation; CRRT: continuous renal replacement therapy; IQR: interquartile range; DM: diabetes mellitus; HTN: hypertension; CHF: congestive heart failure; CAD: coronary heart disease; CKD: chronic kidney disease; GFR: glomerular filtration rate.

Chronic pulmonary disease includes asthma, COPD, bronchiectasis. Cardiac indications for ECMO: cardiac arrest, cardiogenic/obstructive shock (i.e., myocardial infarction, post-cardiotomy, myocarditis, massive PE, cardiomyopathy, and toxic ingestions. Respiratory indications for ECMO: severe ARDS and refractory hypoxemia, severe hypercapnic respiratory failure despite best standard of care.

Table 2. Characteristics and outcomes of ECMO patients who became dialysis-free before hospital discharge.

	Dialysis-free before hospital discharge, N = 81	Dialysis dependent after hospital discharge, N = 25	p Value
Age, years, median [IQR]	52 [39, 59]	51 [43, 58]	.91
Male gender, N (%)	59 (72.8)	22 (88)	.17
DM, N (%)	29 (35.8)	9 (36)	1
HTN, N (%)	57 (70.4)	18 (72)	1
CHF, N (%)	15 (18.5)	6 (24)	.56
CAD, N (%)	17 (21)	8 (32)	.28
Hyperlipidemia, N (%)	26 (32)	13 (52)	.09
Afib/aflutter, N (%)	7 (8.64)	3 (12)	.69
Chronic pulmonary disease, N (%)	27 (33.3)	7 (28)	.80
CKD, N (%)	3 (3.70)	3 (12)	.14
Chronic liver disease, N (%)	0 (0)	1 (4.17)	.22
Body mass index, kg/m^2, median [IQR]	33.2 [29, 40.9]	34.8 [29.4, 43.4]	.54
Days on ECMO, median [IQR]	7 [5, 11.2]	10 [7, 17.3]	.44
Indications for ECMO
Cardiac, N (%)	23 (28.4)	6 (24)	.79
Respiratory, N (%)	58 (71.6)	19 (76)
VV ECMO, N (%)	50 (61.7)	16 (64)	.84
VA ECMO, N (%)	14 (17.3)	5 (20)
VVV, VVA, VAV ECMO, N (%)	17 (21)	4 (16)
GFR on admission, mL/min/1.73 m^2, median [IQR]	74.8 [49, 97.2]	83.9 [68.3, 103]	.11
Days to CRRT initiation from ECMO initiation, median [IQR]	0 [−0.75, 2]	0 [−0.66, 1.15]	.72
Days on CRRT, median [IQR]	8 [4, 13]	12 [6.5, 24.5]	.01
Hours on CRRT, median [IQR]	168 [72, 360]	288 [156, 588]	.01
Fluid balance, mL, median [IQR]	−6183 [−15,110, 3626]	3288 [−9900, 17,271]	.07
Alive, N (%)	76 (83.8)	22 (88)	.38

Table 3. Logistic regression analyses of factors associated with the need for dialysis post-hospitalization.

Variable	Univariate analyses OR (95% CI)	p Value	Multivariate analyses OR (95% CI)	p Value
Hyperlipidemia	2.16 (0.93, 5.04)	.07	6.08 (1.67–22)	.003
Days on CRRT (per day increase)	1.02 (0.99, 1.05)	.07	1.09 (1.03–1.15)	.0007
Fluid balance (per mL increase)	0.99 (0.99–1.00001)	.74	1 (0.99–1.00001)	.93

CRRT: continuous renal replacement therapy; OR: odds ratio; CI: confidence interval.

Data availability statement

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