Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

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No Difference in Risk of Acute Kidney Injury Between Adult Patients Receiving Different Types of Extracorporeal Membrane Oxygenation

10.1101/2020.03.25.20043950 ◽

2020 ◽

Author(s):

Zhixiang Mou ◽

Xu Zhang

Keyword(s):

Acute Kidney Injury ◽

Extracorporeal Membrane Oxygenation ◽

Web Of Science ◽

Meta Analysis ◽

Kidney Injury ◽

Adult Patients ◽

Membrane Oxygenation ◽

Significant Difference ◽

Different Types ◽

Va Ecmo

AbstractAcute kidney injury (AKI) has been reported as one of the most common complications in patients receiving extracorporeal membrane oxygenation (ECMO), yet the risk of AKI on different types of ECMO remains unclear. This meta-analysis aimed to compare risk of AKI among adult patients requiring different types of ECMO. Two authors independently performed a literature search using PubMed, Web of Science, and Embase, encompassing publications up until Arpril 20, 2020 (inclusive). The number of AKI patients, non-AKI patients, patients required RRT and patients not required RRT receiving different types of ECMO were derived and analyzed by STATA. The results indicated there was no significant difference in risk of AKI (OR, 1.54; 95% CI: 0.75-3.16; P= 0.235) and severe AKI required RRT (OR, 1.0; 95% CI: 0.66-1.5, P= 0.994) in patients receiving different types of ECMO. In Conclusion, no difference in risk of AKI and severe AKI required RRT between patients receiving VA ECMO and VV ECMO. More studies are required to support the findings.

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Risk Factors Analysis of Acute Kidney Injury in Adult Patients Receiving Extracorporeal Membrane Oxygenation

10.1101/2020.04.06.20055145 ◽

2020 ◽

Author(s):

Zhixiang Mou

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Liver Cirrhosis ◽

Extracorporeal Membrane Oxygenation ◽

Meta Analysis ◽

Kidney Injury ◽

Ecmo Support ◽

Adult Patients ◽

Severe Bleeding ◽

Membrane Oxygenation

AbstractBackgroundAcute kidney injury (AKI) has been reported as one of the most common complication in patients receiving extracorporeal membrane oxygenation (ECMO), the risk factors of AKI on ECMO is unknown. This meta-analysis aimed to find out the risk factors of AKI among adult patients receiving ECMO.MethodsA literature search was performed using PubMed,Web of Science, and Embase fulfilled the pre-specified criteria until April 2020 to include studies reported the necessary clinic characteristics, then the gender, cancer, diffuse intravascular coagulation (DIC), massive/severe Bleeding, intra-aortic balloon pump (IABP), post-cardiotomy, diabetes mellitus, liver cirrhosis and ECMO support duration were pooled for further analysis by STATA to get conclusion.ResultsThis research is first time to provide the evidence that patients developed AKI/severe AKI with a longer ECMO support duration (pooled WMD, 4.09 days; 95% CI: 2.45-5.73 days, Z= 4.89, P= 0.000, I2= 73.4%, χ2P= 0.023/pooled WMD, 1.52 days; 95% CI: 0.19-2.85 days, Z= 2.25, P= 0.025, I2= 77.4%, χ2P= 0.001) and the risk of severe AKI requiring RRT was higher (pooled OR, 2.22; 95% CI: 1.24-3.99, Z= 2.68, P= 0.007, I2= 0.0%, χ2P= 0.634) in liver cirrhosis patients by systemic analysis, indicated ECMO support duration and liver cirrhosis may act as risk factors of AKI in adult patients received ECMO.

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Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and Meta-Analysis

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2018.03.016 ◽

2018 ◽

Vol 32 (5) ◽

pp. 2087-2093 ◽

Cited By ~ 17

Author(s):

Liangshan Wang ◽

Hong Wang ◽

Xiaotong Hou

Keyword(s):

Systematic Review ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Clinical Outcomes ◽

Meta Analysis ◽

Adult Patients ◽

Membrane Oxygenation ◽

Postcardiotomy Cardiogenic Shock

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Mortality in Patients with Cardiogenic Shock Supported with Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis Evaluating the Impact of Etiology

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2020.01.773 ◽

2020 ◽

Vol 39 (4) ◽

pp. S186

Author(s):

A.C. Alba ◽

F. Foroutan ◽

T.A. Buchan ◽

J. Alvarez ◽

A. Kinsella ◽

...

Keyword(s):

Systematic Review ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Meta Analysis ◽

Membrane Oxygenation ◽

The Impact

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High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-014171 ◽

2017 ◽

Vol 7 (10) ◽

pp. e014171 ◽

Cited By ~ 7

Author(s):

Peng Li ◽

Li-ping Qu ◽

Dong Qi ◽

Bo Shen ◽

Yi-mei Wang ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Meta Analysis ◽

Kidney Injury ◽

High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

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Understanding the ”Extra-Corporeal Membrane Oxygenation Gap" in Veno-Arterial Configuration for Adult Patients: Timing and Causes of Death. Defining the Veno-Arterial Extracorporeal Membrane Oxygenation Gap

10.21203/rs.2.20289/v1 ◽

2020 ◽

Author(s):

Maged Makhoul ◽

Samuel Heuts ◽

Abdulrahman Mansouri ◽

Fabio Silvio Taccone ◽

Amir Obeid ◽

...

Keyword(s):

Systematic Review ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Causes Of Death ◽

Neurological Complications ◽

Multiple Organ ◽

Adult Patients ◽

Membrane Oxygenation ◽

Common Causes ◽

Overall Mortality

Abstract Background Timing and causes of hospital mortality in adult patients undergoing veno-arterial extracorporeal membrane oxygenation (V-A ECMO) have been poorly described. Aim of the current review was to investigate the timing and causes of death of adult patients treated with V-A ECMO, and subsequently define the “V-A ECMO gap”, which represents the patients who are successfully weaned of ECMO but eventually die during hospital stay.Methods A systematic search was performed using electronic MEDLINE and EMBASE databases through PubMed. Studies reporting on adult V-A ECMO patients from January 1993 to October 2018 were screened. Timing, rates and causes of in-hospital mortality were analyzed.Results Sixty studies with 9,181 patients were included in this systematic review. Overall mortality was 37.6% during V-A ECMO support (reported by 60 studies) and 28.9% (57 studies) after weaning. Finally, 32.6% were discharged from hospital (60 studies). Most common causes of death on ECMO were multiple organ failure (MOF, 49.8%), followed by cardiac failure (20.6%) and neurological causes (15.7%). Most common causes of death after weaning were MOF (55.3%), followed by neurological complications (12.6%), persistent heart failure (10.7%) and pulmonary infections (6.8%).Conclusions More than one-third of adult V-A ECMO patients die during ECMO therapy. Additionally, almost one half of successfully weaned patients still decease during hospital stay, defining the “V-A ECMO gap”. Underreporting and lack of uniformity in reporting of important parameters remains problematic in ECMO research. Future studies should uniformly define timing and causes of death in V-A ECMO patients to better understand the effectiveness and complications of this therapy. Systematic review registration PROSPERO 2019 number CRD42019130815

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Risk Factors for Developing Severe Acute Kidney Injury in Adult Patients With Refractory Postcardiotomy Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Critical Care Medicine ◽

10.1097/ccm.0000000000004433 ◽

2020 ◽

Vol 48 (8) ◽

pp. e715-e721

Author(s):

Victoria Lepère ◽

Baptiste Duceau ◽

Guillaume Lebreton ◽

Camille Bombled ◽

Olivier Dujardin ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Kidney Injury ◽

Adult Patients ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Postcardiotomy Cardiogenic Shock

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High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis

Journal of Clinical Pathology ◽

10.1136/jclinpath-2020-207023 ◽

2020 ◽

pp. jclinpath-2020-207023

Author(s):

Camila Barbosa Oliveira ◽

Camilla Albertina Dantas Lima ◽

Gisele Vajgel ◽

Antonio Victor Campos Coelho ◽

Paula Sandrin-Garcia

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Critically Ill ◽

Random Effects ◽

Meta Analysis ◽

Kidney Injury ◽

Random Effects Model ◽

Risk Of Death ◽

Meta Analyses ◽

The Impact

AimsHospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI.MethodsWe systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model.ResultsFrom 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%–100%).ConclusionThe present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients’ outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.

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