Surjit Aswin, Prasannan Bipi, Abraham Jobin, Balagopal Anuroop, Unni Vavullipathy Narayanan
Department of Internal Medicine, Aster Medcity, Kochi, Kerala, India.
Department of Nephrology, Aster Medcity, Kochi, Kerala, India.
Indian J Crit Care Med. 2024 Jan;28(1):26-29. doi: 10.5005/jp-journals-10071-24612.
Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal therapy to support oxygenation of patients with severe cardiac or respiratory failure. Studies have shown that acute kidney injury (AKI) can worsen the outcome in these patients. This study aims to assess the incidence and outcome of AKI in patients on ECMO support.
This retrospective study included 64 patients who underwent ECMO for more than 24 hours. Patients who died within 48 hours of initiation of ECMO and patients with end-stage renal disease (ESRD) on maintenance hemodialysis were excluded. Acute kidney injury was diagnosed and categorized according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.
Of the 64 patients studied, 38 patients (59.38%) developed AKI and 17 patients (44.73%) among them developed AKI within 24 hours of initiation of ECMO. Age, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, hypertension, use of nephrotoxic agents, inotropic support, and poor cardiac function were the risk factors associated with the development of AKI. Diabetes mellitus, type of ECMO used, and duration of ECMO were not found to be risk factors for AKI. Renal replacement therapy was initiated in 31 patients (81.58%). The overall mortality in the whole group was 67.19%, while it was 81.58% among the patients with AKI.
Acute kidney injury was found to be an independent risk factor for mortality in patients on ECMO. Early identification of the risk factors for AKI and management may help to improve the survival rate.
The occurrence of AKI among patients on ECMO support increases the risk of mortality significantly. Hence, measures to prevent AKI, as well as early detection and appropriate management of AKI, would improve patient outcomes.
Surjit A, Prasannan B, Abraham J, Balagopal A, Unni VA. Acute Kidney Injury in Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study. Indian J Crit Care Med 2024;28(1):26-29.
体外膜肺氧合（ECMO）是一种体外治疗模式，用于支持严重心脏或呼吸衰竭患者的氧合。研究表明，急性肾损伤（AKI）会使这些患者的预后恶化。本研究旨在评估接受ECMO支持的患者中AKI的发生率及预后。
这项回顾性研究纳入了64例接受ECMO治疗超过24小时的患者。排除在开始ECMO后48小时内死亡的患者以及维持性血液透析的终末期肾病（ESRD）患者。根据改善全球肾脏病预后组织（KDIGO）标准诊断并分类急性肾损伤。
在研究的64例患者中，38例（59.38%）发生AKI，其中17例（44.73%）在开始ECMO后24小时内发生AKI。年龄、急性生理与慢性健康状况评分系统（APACHE-II）评分、高血压、使用肾毒性药物、使用血管活性药物支持以及心功能差是与AKI发生相关的危险因素。未发现糖尿病、所用ECMO类型及ECMO持续时间是AKI的危险因素。31例患者（81.58%）开始接受肾脏替代治疗。全组总体死亡率为67.19%，而AKI患者中的死亡率为81.58%。
发现急性肾损伤是接受ECMO治疗患者死亡的独立危险因素。早期识别AKI的危险因素并进行管理可能有助于提高生存率。
接受ECMO支持的患者中发生AKI会显著增加死亡风险。因此，预防AKI的措施以及AKI的早期检测和适当管理将改善患者预后。
Surjit A, Prasannan B, Abraham J, Balagopal A, Unni VA. 接受体外膜肺氧合治疗患者的急性肾损伤：一项回顾性队列研究。《印度重症监护医学杂志》2024；28(1):26 - 29。
