Analysis of factors associated with the initiation of renal replacement therapy in patients on veno-arterial extracorporeal membrane oxygenation: a case-control study.

Abstract

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a therapeutic strategy for refractory cardiogenic shock. However, it is associated with a high risk of complications, including acute kidney injury (AKI), which increases the need of renal replacement therapy (RRT) and is linked to worse clinical outcomes.

Objective: To identify clinical and biochemical factors independently associated with the initiation of renal replacement therapy (RRT) in adult patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Methods: A retrospective case-control study that included patients who received VA-ECMO and were admitted to the intensive care unit between 2019 and 2023. The incidence of RRT, along with associated severity and mortality scores, was analyzed using multivariate analysis.

Results: A total of 279 patients were included, among whom 98 received VA-ECMO support. Of these, 26.5% required RRT, and the mortality rate was 57.7%. The majority of patients were male (62.2%), with a mean age of 45.3 years (SD ± 13.8). Factors associated with the need for RRT included the duration of mechanical ventilation (OR, 1.03; 95% CI, 1.00-1.06), history of hypothyroidism (OR, 4.05; 95% CI, 1.27-12.86), and elevated creatinine levels prior to ECMO initiation (OR, 1.54; 95% CI, 1.12-2.09). Additionally, the APACHE II score (OR, 1.04; 95% CI, 0.98-1.10) and renal angina index (OR, 5.29; 95% CI, 1.77-15.77) were predictors of mortality.

Conclusions: Patients undergoing VA-ECMO who require RRT have a high mortality risk. Associated factors include hypothyroidism, elevated creatinine levels before ECMO initiation, and a higher renal angina index. The early identification of these factors may facilitate the early detection of AKI risk and optimize clinical management.

Clinical trial number: Not applicable.