Association of chronic kidney disease with in-hospital mortality of cardiogenic shock patients undergoing veno-arterial extracorporeal membrane oxygenation.

Abstract

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) improves survival in patients with cardiogenic shock (CS), but data on chronic kidney disease (CKD) as a predictor of mortality in these patients is limited.

Aim: To assess the association between CKD and in-hospital mortality in CS patients undergoing VA-ECMO through a systematic review and meta-analysis.

Methods: We reviewed studies up to February 2024 that evaluated CKD's impact on in-hospital mortality in CS patients treated with extracorporeal membrane oxygenation. Databases included PubMed, Google Scholar, EMBASE, and Scopus. A random-effects model was used to calculate the pooled unadjusted odds ratio, I ² statistics to determine heterogeneity, and leave-one-out sensitivity analysis to assess robustness, with P < 0.05 considered statistically significant.

Results: Thirteen studies, involving 12185 CS patients treated with VA-ECMO (mean age 63, 68% males), were included. CKD was significantly associated with an increased in-hospital mortality (odds ratio = 1.89, 95% confidence interval: 1.4-2.55, P < 0.01). Leave-one-out analysis confirms robustness of the association between CKD and increased in-hospital mortality post-extracorporeal membrane oxygenation (I ² = 75%). Despite substantial heterogeneity, the association remains significant, indicating that CKD is a critical risk factor in these patients.

Conclusion: CKD is strongly associated with an increased in-hospital mortality in CS patients treated with VA-ECMO. Despite study heterogeneity, this association remains robust, highlighting CKD as a critical prognostic factor.