Kwon Oh Jin, Aguayo Esteban, Tabibian Kevin, Balian Jeffrey, Chaturvedi Arjun, Yalzadeh Dariush, Hadaya Joseph, Sanaiha Yas, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America.
Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America.
Surg Open Sci. 2025 May 10;26:87-93. doi: 10.1016/j.sopen.2025.04.011. eCollection 2025 Jun.
Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.
A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019-2021 Nationwide Readmissions Database. Patients were stratified into , , and based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.
Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as . Following risk adjustment, was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10-1.59) and overall complications (AOR 1.72, 95%CI 1.09-2.72) compared to . Additionally, both and were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.
Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.
尽管静脉-动脉体外膜肺氧合（VA-ECMO）作为急性心脏和循环衰竭的高级循环支持手段的应用越来越多，但其高发病率和死亡率使得识别风险因素成为必要。VA-ECMO患者中慢性肾脏病（CKD）的患病率仍不清楚，其与预后的关系也尚未明确确立。
使用2019 - 2021年全国再入院数据库对接受VA-ECMO治疗的患者（≥18岁）进行回顾性分析。根据肾脏疾病严重程度将患者分为轻度、中度和重度。排除需要透析的终末期肾病患者或既往有肾移植的患者。主要结局是住院死亡率，同时对围手术期并发症进行次要评估。采用多变量回归模型评估VA-ECMO不同适应证下CKD严重程度与结局之间的关联。
在估计纳入分析的15432例患者中，11.7%患有CKD，其中84.7%为轻度。经过风险调整后，与轻度CKD相比，中度CKD独立增加住院死亡率（调整后比值比[AOR] 1.32，95%置信区间[CI] 1.10 - 1.59）和总体并发症（AOR 1.72，95%CI 1.09 - 2.72）的几率。此外，中度和重度CKD均与心脏和急性肾衰竭并发症风险增加有关。在对VA-ECMO不同适应证进行评估时用于心脏手术后休克、心源性休克和混合心肺支持时，重度CKD与最高的风险调整死亡率相关。
晚期CKD与VA-ECMO患者死亡率增加和围手术期并发症独立相关，突出了既往存在的肾功能不全与不良结局之间的关联。
