title: Relationship between renal function and extracorporeal membrane oxygenation use: a single-center experience.
abstract: The effects of extracorporeal membrane oxygenation (ECMO) support on renal function in children with critical illness are unknown. The objective of this study was to investigate the impact of ECMO on renal function among children in different age groups. We performed a single-center retrospective observational study in critically ill children ≤ 18 years supported on ECMO for refractory cardiac or pulmonary failure (2006-2012). The patient population was divided into four age groups for the purpose of comparisons. The Acute Kidney Injury Network's (AKIN's) validated, three-tiered staging system for acute kidney injury was used to categorize the degree of worsening renal function. Data on patient demographics, baseline characteristics, renal function parameters, dialysis, ultrafiltration, duration of mechanical cardiac support, and mortality were collected. Comparisons of baseline characteristics, duration of mechanical cardiac support, and renal function were made between the four age groups. During the study period, 311 patients qualified for inclusion, of whom 289 patients (94%) received venoarterial (VA) ECMO, 12 (4%) received venovenous (VV) ECMO, and 8 (3%) received both VV and VA ECMO. A total of 109 patients (36%) received ultrafiltration on ECMO, 58 (19%) received hemodialysis, and 51 (16%) received peritoneal dialysis. There was a steady and sustained improvement in renal function in all age groups during the ECMO run, with the maximum and longest-sustained improvement occurring in the oldest age group. Proportions of patients in different AKIN stages remained similar in the first 7 days after ECMO initiation. We demonstrate that renal dysfunction improves early after ECMO support. Irrespective of the underlying disease process or patient age, renal function improves in children with pulmonary or cardiac failure who are placed on ECMO.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Division of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.forename: Jacob
authors.initials: J
authors.lastname: Carlson
authors.forename: Dennis
authors.initials: D
authors.lastname: Wells
authors.forename: Patrick
authors.initials: P
authors.lastname: Selakovich
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Robertson
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.forename: Eudice E
authors.initials: EE
authors.lastname: Fontenot
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Steiner
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D000293:Adolescent; D000367:Age Factors; D001131:Arkansas; D002648:Child; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007668:Kidney / Q000503:physiopathology*; D020127:Recovery of Function; D012131:Respiratory Insufficiency / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extracorporeal membrane oxygenation; Intensive care unit; Pediatric cardiopulmonary support; Renal function