Kidney & extracorporeal support interactions: a narrative review

Acute kidney injury (AKI) is common in critically ill patients, especially among those with severe and advanced organ failure. The use of extracorporeal support (ECS) is frequently considered. Machines, filter technology and techniques for extracorporeal organ support continue to expand quickly. The aim of this review is to describe the interactions between different types of ECS techniques and kidney function.

There is a bidirectional relationship between AKI and ECS techniques, including renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO), hemoadsorption and cardiac support devices. Patients with AKI frequently need ECS but all devices can also potentially contribute to AKI and other complications. The main mechanisms of ECS-associated AKI include comorbidities, risk factors associated with critical illness in general, vascular complications linked to ECS, inflammation, hypoperfusion and ischemia-reperfusion injury.

The pace of technological advancement of ECS techniques is expanding quickly but outpacing research and data on both the effectiveness and risk or morbidity with these devices. More research is urgently needed.