Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation

Abstract Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used primarily for reversible cardiopulmonary failure across the lifespan. Mortality from multiple organ failure on ECMO is high, and unfortunately, complications such as acute kidney injury (AKI) and disorders of fluid balance such as fluid overload (FO) necessitating continuous renal replacement therapy (CRRT) are also common. The largest series of AKI, FO and ECMO related outcomes has been published by the Kidney Interventions During Membrane Oxygenation (KIDMO) multicenter study, which demonstrated patients with AKI and FO have worse outcomes, corroborating with findings from previous single center studies. There are multiple ways to perform CRRT during ECMO, but integration of a CRRT machine in series is the most common approach in neonates and children. The optimal timing of when to initiate CRRT, and how fast to remove fluid during ECMO remain unknown, and there is an urgent need to design studies with these research questions in mind. The disposition and clearance of drugs on ECMO also require urgent study, as drugs metabolism not only is disproportionately affected by the presence of AKI and FO, but also by CRRT prescription and the rate of fluid removal. In this review, we discuss the contemporary epidemiology and outcomes of AKI and FO during ECMO, as well as the use of concurrent CRRT and highlight evidence gaps as a research map.

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Publication Details

Journal
Intensive Care Medicine – Paediatric and Neonatal
Published
2024-09-13
DOI
https://doi.org/10.1007/s44253-024-00051-4
Citations
3
Primary Topic
Acute Kidney Injury Research
Type
article
Field-Weighted Citation Impact
1.02
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article

Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation

Rahul Chanchlani, Ahmad Kaddourah, Sarah N. Fernández, Dana Y. Fuhrman et al.
3 citations
Intensive Care Medicine – Paediatric and Neonatal
Acute Kidney Injury Research
1.02
article

Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation

Rahul Chanchlani, Ahmad Kaddourah, Sarah N. Fernández, Dana Y. Fuhrman, Ayse Akcan‐Arikan, Shina Menon, Amy E. Strong, Rajit K. Basu, Matthew L. Paden, Zaccaria Ricci, Stephen M. Gorga, Katja M. Gist, Brian C. Bridges, Claus Peter Schmitt, Ben Gelbart, Asma Salloo, Heidi J. Steflik, Patricia Bastero, David T. Selewski, Tara Beck
article en
3 citations

Abstract

Abstract Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used primarily for reversible cardiopulmonary failure across the lifespan. Mortality from multiple organ failure on ECMO is high, and unfortunately, complications such as acute kidney injury (AKI) and disorders of fluid balance such as fluid overload (FO) necessitating continuous renal replacement therapy (CRRT) are also common. The largest series of AKI, FO and ECMO related outcomes has been published by the Kidney Interventions During Membrane Oxygenation (KIDMO) multicenter study, which demonstrated patients with AKI and FO have worse outcomes, corroborating with findings from previous single center studies. There are multiple ways to perform CRRT during ECMO, but integration of a CRRT machine in series is the most common approach in neonates and children. The optimal timing of when to initiate CRRT, and how fast to remove fluid during ECMO remain unknown, and there is an urgent need to design studies with these research questions in mind. The disposition and clearance of drugs on ECMO also require urgent study, as drugs metabolism not only is disproportionately affected by the presence of AKI and FO, but also by CRRT prescription and the rate of fluid removal. In this review, we discuss the contemporary epidemiology and outcomes of AKI and FO during ECMO, as well as the use of concurrent CRRT and highlight evidence gaps as a research map.

Intensive Care Medicine – Paediatric and NeonatalVol. 2(1)
Cincinnati Children's Hospital Medical Center (US), Qatar Airways (Qatar) (QA), Royal Children's Hospital (AU), Lucile Packard Children's Hospital (US), Medical University of South Carolina (US), University of Cape Town (ZA), Baylor College of Medicine (US), Heidelberg University (DE), McMaster Children's Hospital (CA), University Hospital Heidelberg (DE), Hospital General Universitario Gregorio Marañón (ES), University of Iowa Stead Family Children’s Hospital (US), Meyer Children's Hospital (IT), Lurie Children's Hospital (US), Sidra Medical and Research Center (QA), Children's Hospital of Pittsburgh (US), Children's Healthcare of Atlanta (US), Texas Children's Hospital (US), C. S. Mott Children's Hospital (US), Red Cross War Memorial Children's Hospital (ZA), McMaster University (CA)
Openalex Percentile: Top 21%
Acute Kidney Injury Research
1.02
DOIOpen Access PDFOpenAlex
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