Lumlertgul Nuttha, Wright Rebeka, Hutson Gareth, Milicevic Jovana Kusic, Vlachopanos Georgios, Lee Ken Cheah Hooi, Pirondini Leah, Gregson John, Sanderson Barnaby, Leach Richard, Camporota Luigi, Barrett Nicholas A, Ostermann Marlies
Department of Critical Care, Guy's & St Thomas' Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, UK.
Division of Nephrology and Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Ann Intensive Care. 2022 Jul 23;12(1):70. doi: 10.1186/s13613-022-01046-0.
Acute kidney injury (AKI) is a frequent complication in patients with severe respiratory failure receiving extracorporeal membrane oxygenation (ECMO). However, little is known of long-term kidney function in ECMO survivors. We aimed to assess the long-term mortality and kidney outcomes in adult patients treated with veno-venous ECMO (VV-ECMO).
This was a single-centre retrospective study of adult patients (≥ 18 years old) who were treated with VV-ECMO at a commissioned ECMO centre in the UK between 1st September 2010, and 30th November 2016. AKI was defined and staged using the serum creatinine and urine output criteria of the Kidney Diseases: Improving Global Outcomes (KDIGO) classification. The primary outcome was 1-year mortality. Secondary outcomes were long-term mortality (up to March 2020), 1-year incidence of end-stage kidney disease (ESKD) or chronic kidney disease (CKD) among AKI patients who received renal replacement therapy (AKI-RRT), AKI patients who did not receive RRT (AKI-no RRT) and patients without AKI (non-AKI).
A total of 300 patients [57% male; median age 44.5; interquartile range (IQR) 34-54] were included in the final analysis. Past medical histories included diabetes (12%), hypertension (17%), and CKD (2.3%). The main cause of severe respiratory failure was pulmonary infection (72%). AKI occurred in 230 patients (76.7%) and 59.3% received renal replacement therapy (RRT). One-year mortality was 32% in AKI-RRT patients vs. 21.4% in non-AKI patients (p = 0.014). The median follow-up time was 4.35 years. Patients who received RRT had a higher risk of 1-year mortality than those who did not receive RRT (adjusted HR 1.80, 95% CI 1.06, 3.06; p = 0.029). ESKD occurred in 3 patients, all of whom were in the AKI-RRT group. At 1-year, 41.2% of survivors had serum creatinine results available. Among these, CKD was prevalent in 33.3% of AKI-RRT patients vs. 4.3% in non-AKI patients (p = 0.004).
VV-EMCO patients with AKI-RRT had high long-term mortality. Monitoring of kidney function after hospital discharge was poor. In patients with follow-up creatinine results available, the CKD prevalence was high at 1 year, especially in AKI-RRT patients. More awareness about this serious long-term complication and appropriate follow-up interventions are required.
急性肾损伤（AKI）是接受体外膜肺氧合（ECMO）治疗的严重呼吸衰竭患者常见的并发症。然而，对于ECMO幸存者的长期肾功能了解甚少。我们旨在评估接受静脉-静脉ECMO（VV-ECMO）治疗的成年患者的长期死亡率和肾脏结局。
这是一项对2010年9月1日至2016年11月30日期间在英国一家指定的ECMO中心接受VV-ECMO治疗的成年患者（≥18岁）进行的单中心回顾性研究。根据《改善全球肾脏病预后（KDIGO）》分类的血清肌酐和尿量标准定义并分期AKI。主要结局是1年死亡率。次要结局是长期死亡率（至2020年3月）、接受肾脏替代治疗（AKI-RRT）的AKI患者、未接受RRT的AKI患者（AKI-no RRT）和无AKI患者（非AKI）中终末期肾病（ESKD）或慢性肾脏病（CKD）的1年发病率。
最终分析纳入了300例患者[男性占57%；中位年龄44.5岁；四分位间距（IQR）为34 - 54岁]。既往病史包括糖尿病（12%）、高血压（17%）和CKD（2.3%）。严重呼吸衰竭的主要原因是肺部感染（72%）。230例患者（76.7%）发生AKI，59.3%接受了肾脏替代治疗（RRT）。AKI-RRT患者的1年死亡率为32%，而非AKI患者为21.4%（p = 0.014）。中位随访时间为4.35年。接受RRT的患者1年死亡风险高于未接受RRT的患者（校正风险比1.80，95%置信区间1.06，3.06；p = 0.029）。3例患者发生ESKD，均在AKI-RRT组。1年时，41.2%的幸存者有血清肌酐结果。其中，CKD在33.3%的AKI-RRT患者中普遍存在，而非AKI患者中为4.3%（p = 0.004）。
接受AKI-RRT的VV-EMCO患者长期死亡率高。出院后肾功能监测不佳。在有随访肌酐结果的患者中，1年时CKD患病率高，尤其是在AKI-RRT患者中。需要更多地关注这一严重的长期并发症并进行适当的随访干预。
