The Incidence of Acute Kidney Injury and Its Effect on Neonatal and Pediatric Extracorporeal Membrane Oxygenation Outcomes: A Multicenter Report From the Kidney Intervention During Extracorporeal Membrane Oxygenation Study Group

• Authors: Geoffrey M. Fleming, Vanderbilt University; Rashmi Sahay, Cincinnati Children's Hospital Medical Center; Michael Zappitelli, McGill University; Eileen King, Cincinnati Children's Hospital Medical Center; David J. Askenazi, University of Alabama Birmingham; Brian C. Bridges, Vanderbilt University; Matthew L Paden, Emory University; David T. Selewski, University of Michigan; David S. Cooper, Cincinnati Children's Hospital Medical Center
• Journal Title: Pediatric Critical Care Medicine
• Volume: Volume 17, Number 12
• Publisher: Lippincott, Williams & Wilkins | 2016-12-01, Pages 1157-1169
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/PCC.0000000000000970
• Subjects: Health Sciences, Medicine and Surgery; Biology, Biostatistics; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Critical Care Medicine; Pediatrics; General & Internal Medicine; acute kidney injury; acute renal failure; extracorporeal membrane oxygenation; renal dialysis; ACUTE-RENAL-FAILURE; INTENSIVE-CARE-UNIT; CONTINUOUS VENOVENOUS HEMOFILTRATION; LIFE-SUPPORT ORGANIZATION; CRITICALLY-ILL CHILDREN; LENGTH-OF-STAY; RESPIRATORY-FAILURE; REPLACEMENT THERAPY; SERUM CREATININE; FLUID OVERLOAD

Abstract

Objective: In a population of neonatal and pediatric patients on extracorporeal membrane oxygenation; to describe the prevalence and timing of acute kidney injury utilizing a consensus acute kidney injury definition and investigate the association of acute kidney injury with outcomes (length of extracorporeal membrane oxygenation and mortality). Design: Multicenter retrospective observational cohort study. Setting: Six pediatric extracorporeal membrane oxygenation centers. Patients: Pediatric patients (age, < 18 yr) on extracorporeal membrane oxygenation at six centers during a period of January 1, 2007, to December 31, 2011. Interventions: None. Measurements and Main Results: Complete data were analyzed for 832 patients on extracorporeal membrane oxygenation. Sixty percent of patients had acute kidney injury utilizing the serum creatinine Kidney Disease Improving Global Outcomes criteria (AKI SCr ) and 74% had acute kidney injury using the full Kidney Disease Improving Global Outcomes criteria including renal support therapy (AKI SCr + RST ). Of those who developed acute kidney injury, it was present at extracorporeal membrane oxygenation initiation in a majority of cases (52% AKI SCr and 65% AKI SCr + RST ) and present by 48 hours of extracorporeal membrane oxygenation support in 86% (AKI SCr ) and 93% (AKI SCr + RST ). When adjusted for patient age, center of support, mode of support, patient complications and preextracorporeal membrane oxygenation pH, the presence of acute kidney injury by either criteria was associated with a significantly longer duration of extracorporeal membrane oxygenation support (AKI SCr , 152 vs 110 hr; AKI SCr + RST , 153 vs 99 hr) and increased adjusted odds of mortality at hospital discharge (AKI SCr : odds ratio, 1.77; 1.22-2.55 and AKI SCr + RST : odds ratio, 2.50; 1.61-3.90). With the addition of renal support therapy to the model, acute kidney injury was associated with a longer duration of extracorporeal membrane oxygenation support (AKI SCr , 149 vs 121 hr) and increased risk of mortality at hospital discharge (AKI SCr : odds ratio, 1.52; 1.04-2.21). Conclusion: Acute kidney injury is present in 60-74% of neonatal-pediatric patients supported on extracorporeal membrane oxygenation and is present by 48 hours of extracorporeal membrane oxygenation support in 86-93% of cases. Acute kidney injury has a significant association with increased duration of extracorporeal membrane oxygenation support and increased adjusted odds of mortality at hospital discharge.