Key Factors in Posthospitalization Dialysis Dependence in Patients on Extracorporeal Membrane Oxygenation (ECMO)-CRRT

Background: Patients requiring both ECMO and continuous renal replacement therapy (CRRT) represent a high risk for poor renal outcomes. While acute kidney injury (AKI) is common in this group, the long-term risk of dialysis dependence after discharge remains understudied. Methods: We conducted a retrospective cohort study of adult patients who received both ECMO and CRRT at a tertiary medical center between 2015 and 2022. Patients with pre-existing end-stage renal disease were excluded. The primary outcome was dialysis dependence in a 120-day follow-up after discharge. Logistic regression was used to identify factors associated with persistent dialysis dependence. Results: Of 191 patients requiring ECMO and CRRT, 85 (45%) survived to discharge. Among them, 18 (21%) remained dialysis dependent at 120 days[KK1] . These patients had significantly longer hospital stays (87.6 vs. 53.6 days, p = 0.001) and longer CRRT durations. Multivariate analysis showed hospital length of stay was independently associated with dialysis dependence (OR 1.02, 95% CI 1.004–1.041, p = 0.0046). Conclusion: Approximately one in five ECMO-CRRT survivors remained dialysis dependent four months after discharge. Prolonged hospitalization was the strongest predictor of continued dialysis need, highlighting the long-term burden of critical illness and the importance of early post-discharge nephrology follow-up.