Factors associated with acute kidney injury in patients on extracorporeal membrane oxygenation support: A retrospective cohort study.

Abstract

IntroductionAcute kidney injury (AKI) is prevalent in critically ill patients, especially in those needing extracorporeal membrane oxygenation (ECMO) due to cardiogenic shock or acute respiratory distress syndrome. The incidence of AKI in this patient population varies from 26% to 85%. This study explored the factors associated with AKI after the initiation of ECMO in the intensive care unit (ICU).MethodsA retrospective cohort study was conducted, including patients aged 18 years and above undergoing veno-arterial or veno-venous ECMO between 1 January, 2020 and 1 May, 2023.ResultsA total of 267 patients undergoing ECMO were included in this study. The development of AKI was associated with the use of vasopressors, specifically norepinephrine (odds ratio [OR]: 3.7, 95% confidence interval [95% CI]: 1.65-8.14) and vasopressin (OR: 2.5, 95% CI: 1.49-4.30).The protective factors included heparin use (OR: 0.51, 95% CI: 0.26-0.97) and the absence of vasopressors (OR: 0.39, 95% CI: 0.17-0.77).ConclusionsAKI poses a significant concern in critically ill patients undergoing ECMO. Multiple risk factors were identified, including vasopressor use and ECMOrelated complications. Identifying risks and protective factors is crucial for optimising ECMO management to reduce complications and mortality risk. Further studies are needed to understand the exact mechanisms of AKI during ECMO, which can inform the development of new targeted intervention checkpoints to improve outcomes in critically ill patients undergoing ECMO.