Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Charat Thongprayoon; Wisit Cheungpasitporn; Ploypin Lertjitbanjong; Narothama Reddy Aeddula; Tarun Bathini; Kanramon Watthanasuntorn; Narat Srivali; Michael A Mao; Kianoush Kashani

doi:10.3390/jcm8070981

Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

J Clin Med. 2019 Jul 5;8(7):981. doi: 10.3390/jcm8070981.

Authors

Charat Thongprayoon¹, Wisit Cheungpasitporn², Ploypin Lertjitbanjong³, Narothama Reddy Aeddula⁴, Tarun Bathini⁵, Kanramon Watthanasuntorn³, Narat Srivali⁶, Michael A Mao⁷, Kianoush Kashani^{8

9}

Affiliations

¹ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
² Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
³ Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA.
⁴ Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA.
⁵ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
⁶ Division of Pulmonary and Critical Care Medicine, St. Agnes Hospital, Baltimore, MD 21229, USA.
⁷ Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA.
⁸ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA. Kashani.Kianoush@mayo.edu.
⁹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. Kashani.Kianoush@mayo.edu.

Abstract

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO.

Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527).

Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%-72.4%) and 44.9% (95%CI: 40.8%-49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87-4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21-4.99). There was no publication bias as evaluated by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively.

Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

Keywords: AKI; ECMO; acute kidney injury; epidemiology; extracorporeal membrane oxygenation; meta-analysis.