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Updated: Jun 17, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Acute Kidney Injury, Renal Replacement Therapy, and Extracorporeal Membrane Oxygenation Treatment During the COVID-19
Fabrizio Ceresa1, Paolo Monardo2, Antonio Lacquaniti2
1Cardio-Vascular and Thoracic Department, Papardo Hospital, 98158 Messina, Italy.
Insights
Acute kidney injury (AKI) is common in severe COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO). Early renal replacement therapy (RRT) significantly reduces mortality in these critically ill patients.
Area of Science:
- Critical Care Medicine
- Nephrology
- Infectious Diseases
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) caused a global pandemic, with many patients developing coronavirus disease 2019 (COVID-19).
- A significant number of COVID-19 patients, particularly those needing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS), developed acute kidney injury (AKI).
Purpose of the Study:
- To assess the prognostic significance of AKI in COVID-19 patients requiring intensive care unit (ICU) support.
- To evaluate risk factors and outcomes associated with AKI and renal replacement therapy (RRT) in this patient population.
- To determine the mortality rate among patients treated with ECMO.
Main Methods:
- Retrospective observational study of 396 patients admitted to the ICU with SARS-CoV-2 infection between November 2020 and December 2022.
- Selection criteria included severe ARDS requiring veno-venous (vv) ECMO support and AKI.
- Analysis of AKI stages, need for RRT, risk factors, and outcomes, including mortality rates.
Main Results:
- The 30-day mortality rate after ECMO initiation was 85.7%.
- Early implementation of RRT with a high cut-off (HCO) hemofilter showed a significant survival advantage for both ICU mortality and 15-day mortality post-vv-ECMO.
- Early onset of vasoplegic shock after ECMO implantation was associated with a higher risk of death during ICU stay.
Conclusions:
- COVID-19 is associated with a high risk of AKI and the need for RRT.
- Hypertension, pre-existing renal disease, and mechanical ventilation were identified as independent risk factors for AKI in this cohort.
- While ECMO-supported patients faced high mortality, early RRT implementation was linked to reduced mortality during ICU stay.
Abstract:
Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) was described in December 2019 for the first time, and it was responsible for a global pandemic. An alarming number of patients with coronavirus disease 2019 (COVID-19) also developed acute kidney injury (AKI), especially those who required extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS). The aim of our retrospective observational study was to assess the prognostic significance of AKI in these patients. This study observed, in COVID-19 patients admitted to an intensive care unit (ICU), AKI stages and the need for renal replacement therapy (RRT), assessing the risk factors and outcomes. Moreover, we evaluated the mortality rate of patients treated by ECMO. Materials and Methods: Between November 2020 and December 2022, among 396 patients admitted to our intensive care unit (ICU) diagnosed with SARS-CoV-2 infection, we selected patients with severe ARDS requiring veno-venous (vv) ECMO support and AKI. Results: The 30-day mortality after ECMO positioning was 85.7%. A Cox regression revealed a significant advantage for RRT with a high cut-off (HCO) hemofilter both for ICU mortality (HR 0.17 [95% CI: 0.031-0.935], p = 0.035) and 15 day-mortality after the start of vv-ECMO (HR 0.13 [95%CI: 0.024-0.741], p= 0.021), whereas the early onset of vasoplegic shock after ECMO implantation indicated a higher risk of death (HR 11.55 [95% CI: 1.117-119.567], p = 0.04) during the ICU stay. Conclusions: COVID-19 induces a high risk of AKI and RRT. In our cohort, hypertension, pre-existing renal disease, and mechanical ventilation represented independent risk factors for AKI. Patients requiring ECMO support had a high mortality rate. The early implementation of RRT reduced the risk of death during the ICU stay.
