The impact of CRRT modality in patients with AKI receiving ECMO: A nationwide registry study in Taiwan.

Abstract

PURPOSE:

Patients receiving extracorporeal membrane oxygenation (ECMO) commonly develop acute kidney injury (AKI) and frequently require continuous renal replacement therapy (CRRT). The impact of different CRRT modalities on survival in patients receiving ECMO remains unclear.

MATERIALS AND METHODS:

Using claims data from Taiwan's National Health Insurance Research Database, a total of 1077 patients who received ECMO and either continuous venovenous hemofiltration (CVVH) or continuous venovenous hemodialysis (CVVHD) for AKI were identified. Inverse probability of treatment weighting was applied using propensity scores to balance the baseline covariates of the two groups. The primary outcome was in-hospital morality.

RESULTS:

We identified 1077 patients (mean age 57.9; 71.8% men). Postcardiotomy shock (49.2%) was the most frequently reported indication for ECMO. The CVVH group had a lower risk of in-hospital mortality (68.4% vs. 76.9%; odds ratio 0.65; 95% confidence interval [CI] 0.50-0.85) compared with the CVVHD group. The CVVH group also had a shorter mean ICU stay compared with the CVVHD group (mean difference -4.59 days, 95% CI -9.15 to -0.03 days).

CONCLUSION:

Our results suggest that compared with CVVHD, CVVH may be associated with a lower risk of in-hospital mortality in patients with AKI who receive ECMO.

• Authors: Cheng-Chia Lee, Shao-Wei Chen, Ya-Lien Cheng, Pei-Chun Fan, Tsung-Yu Tsai, Ming-Jen Chan, Su-Wei Chang, Hsiang-Hao Hsu, Ji-Tseng Fang, Chih-Hsiang Chang
• Journal: Journal of critical care (J Crit Care) Vol. 57 Pg. 102-107 (06 2020) ISSN: 1557-8615 [Electronic] United States
• PMID: 32088523 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Acute Kidney Injury (therapy)
• Adult
• Aged
• Continuous Renal Replacement Therapy (methods)
• Extracorporeal Membrane Oxygenation (methods)
• Female
• Hemofiltration
• Hospital Mortality
• Humans
• Inflammation
• Male
• Middle Aged
• Odds Ratio
• Registries
• Taiwan (epidemiology)
• Treatment Outcome
• Young Adult