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Kidney & extracorporeal support interactions: a narrative review.
Michael J Connor1,2, Marlies Ostermann3
1Emory University School of Medicine; Department of Medicine; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine.
Current Opinion in Critical Care
|October 30, 2025
Summary
Extracorporeal support (ECS) is crucial for critically ill patients with acute kidney injury (AKI). However, these devices can also cause AKI through various mechanisms, necessitating further research into their complex interactions.
Area of Science:
- Critical Care Medicine
- Nephrology
- Biomedical Engineering
Background:
- Acute kidney injury (AKI) is prevalent in critically ill patients, often requiring extracorporeal support (ECS).
- Technological advancements in ECS are rapidly evolving, impacting patient care and outcomes.
Purpose of the Study:
- To review the complex interactions between various extracorporeal support (ECS) techniques and kidney function.
- To elucidate the bidirectional relationship between AKI and ECS.
Main Methods:
- Literature review of current extracorporeal support (ECS) techniques.
- Analysis of the impact of ECS on kidney function in critically ill patients.
Main Results:
- A bidirectional relationship exists between AKI and ECS, including renal replacement therapy (RRT), ECMO, hemoadsorption, and cardiac support.
- ECS devices, while treating AKI, can also precipitate AKI and other complications.
- Mechanisms of ECS-associated AKI include comorbidities, critical illness factors, vascular issues, inflammation, hypoperfusion, and ischemia-reperfusion injury.
Conclusions:
- Rapid technological progress in ECS outpaces research on effectiveness and risks.
- Urgent research is needed to understand the full impact and optimize the use of ECS in AKI.
- Further investigation into device-specific complications and patient outcomes is essential.
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