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Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to
Amy E Strong1,2, Spandana Makeneni3, Diego Campos4
1Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Pediatric patients surviving extracorporeal membrane oxygenation (ECMO) face a significant burden of long-term kidney disease, including acute kidney injury (AKI) and chronic kidney disease (CKD). Incomplete kidney function monitoring post-ECMO is a concern, necessitating further research to address this vulnerability.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Extracorporeal Membrane Oxygenation (ECMO)
Background:
- Long-term kidney outcomes following pediatric extracorporeal membrane oxygenation (ECMO) are not well-defined.
- Understanding kidney dysfunction screening and long-term kidney disease prevalence is crucial for survivors.
Purpose of the Study:
- To describe kidney dysfunction screening frequency during follow-up in pediatric ECMO survivors.
- To determine the prevalence of long-term kidney disease, including acute kidney injury (AKI) and chronic kidney disease (CKD), after ECMO.
Main Methods:
- Retrospective cohort study of pediatric ECMO survivors (2009-2019).
- Kidney outcomes defined using estimated glomerular filtration rate (eGFR) from post-discharge serum creatinine values.
- Defined AKI, abnormal eGFR, and CKD based on specific eGFR thresholds and time intervals.
Main Results:
- Of 399 survivors followed for a median of 5 years, 264 had post-discharge creatinine values.
- 23% had abnormal eGFR, and 9% met criteria for CKD (18 patients).
- Of those with CKD, 67% had prior AKI during ECMO, and 39% experienced post-discharge AKI events.
Conclusions:
- Pediatric ECMO survivors experience a substantial burden of long-term kidney disease.
- Kidney function monitoring was incomplete in this cohort, highlighting a significant concern.
- Further research is needed to mitigate post-ECMO kidney vulnerability and improve long-term outcomes.
Objectives:
Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease.
Design:
Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m 2 ) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m 2 , which subsequently improved to normal (≥ 90 mL/min/1.73 m 2 ); 2) abnormal eGFR of less than 90 mL/min/1.73 m 2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m 2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR.
Setting:
Single-center tertiary care children's hospital system.
Patients:
All pediatric patients surviving ECMO from 2009 to 2019.
Interventions:
None.
Measurements And Main Results:
In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3-8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1-6 episodes).
Conclusions:
This 2009-2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.
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