title: Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation.
abstract: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can improve survival in patients with cardiogenic shock or cardiac arrest. We investigated the association between initial renal function and clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest.
  
  
  
  This was a single-center, retrospective cohort study of 287 patients who underwent ECMO at our hospital from January 2005 to December 2014. We excluded 70 patients with non-cardiogenic events. The remaining 217 patients were divided into 2 groups according to initial estimated glomerular filtration rate (eGFR): Initial high eGFR (non-renal failure: non-RF) group: eGFR≥60ml/min/1.73m2(n=73) and initial low eGFR (RF) group: eGFR<60ml/min/1.73m2(n=144). Clinical outcome was defined as all-cause death at 30 days after extracorporeal life support.
  
  
  
  VA-ECMO was begun in 87% of patients for cardiac arrest. The non-RF group was significantly younger (51.6 vs. 62.6 years), had lower body mass index (22.8 vs. 24.7kg/m2), lower blood urea nitrogen (14.4 vs. 23.9mg/dl), and lower K (4.0 vs. 4.5mEq/l, all p<0.05) than the RF group. Incidence of all-cause death at 30 days was significantly lower in the non-RF than RF group (49% vs. 76%, p<0.0001). Initial low eGFR was an independent predictor of mortality after adjustment for multiple cofounders (OR: 4.08, 95% CI: 1.77-9.42, p<0.001). Kaplan-Meier curve showed better outcome in the non-RF versus RF group (p=0.0009).
  
  
  
  An initial low eGFR may predict worse clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest.
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kuroki
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. Electronic address: daisuke-a@mtg.biglobe.ne.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
authors.affiliation: Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Akashi
authors.affiliation: Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hamabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
mesh_terms: D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005919:Glomerular Filtration Rate; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy
keywords: Cardiopulmonary bypass; Cardiopulmonary resuscitation; Chronic kidney disease; Estimated glomerular filtration rate; Extracorporeal membrane oxygenation; Shock