Department of Anesthesiology and Pain Medicine.
Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
ASAIO J. 2022 Sep 1;68(9):1149-1157. doi: 10.1097/MAT.0000000000001622. Epub 2021 Dec 1.
We aimed to investigate the prevalence and associated factors of newly diagnosed end-stage renal disease (ESRD) requiring renal-replacement therapy (RRT) among survivors of extracorporeal membrane oxygenation (ECMO) and determine whether newly diagnosed ESRD is associated with poorer long-term survival outcomes. All adult patients who underwent ECMO between 2005 and 2018 were included, and ECMO survivors were those who survived more than 365 days after ECMO support. ECMO survivors with a history of pre-ECMO RRT were excluded. A total of 5,898 ECMO survivors were included in the analysis. At the 1-year post-ECMO follow-up, 447 patients (7.6%) were newly diagnosed with ESRD requiring RRT. Preexisting renal disease (odds ratio [OR]: 2.83), increased duration of continuous RRT during hospitalization (OR: 1.16), the cardiovascular group ( vs. respiratory group; OR: 1.78), and the postcardiac arrest group ( vs . respiratory group; OR: 2.52) were associated with newly diagnosed ESRD. Moreover, patients with newly diagnosed ESRD were associated with a 1.56-fold higher risk of 3-year all-cause mortality than those in the control group (hazard ratio: 1.56). At the 1-year post-ECMO follow-up, 7.6% of ECMO survivors were newly diagnosed with ESRD requiring RRT. Moreover, post-ECMO ESRD was associated with poorer long-term survival among ECMO survivors.
我们旨在调查体外膜氧合 (ECMO) 幸存者中新诊断的需要肾脏替代治疗 (RRT) 的终末期肾脏疾病 (ESRD) 的患病率和相关因素,并确定新诊断的 ESRD 是否与较差的长期生存结果相关。纳入 2005 年至 2018 年间接受 ECMO 的所有成年患者,ECMO 幸存者是指 ECMO 支持后存活超过 365 天的患者。排除 ECMO 前有 RRT 史的 ECMO 幸存者。共有 5898 名 ECMO 幸存者纳入分析。在 ECMO 后 1 年的随访中,447 名患者(7.6%)新诊断为需要 RRT 的 ESRD。存在预先存在的肾脏疾病(比值比 [OR]:2.83)、住院期间持续 RRT 时间延长(OR:1.16)、心血管组(与呼吸组相比;OR:1.78)和心脏骤停后组(与呼吸组相比;OR:2.52)与新诊断的 ESRD 相关。此外,与对照组相比,新诊断为 ESRD 的患者在 3 年内全因死亡率的风险增加了 1.56 倍(风险比:1.56)。在 ECMO 后 1 年的随访中,7.6%的 ECMO 幸存者新诊断为需要 RRT 的 ESRD。此外,ECMO 后 ESRD 与 ECMO 幸存者的长期生存较差相关。