Abstract: FR-PO090
Impact of Kidney Replacement Therapy during Extracorporeal Membrane Oxygenation Support in Terms of Mortality: A Systematic Review and Meta-Analysis
Session Information
- AKI: Diagnosis and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Guru, Pramod K., Mayo Clinic, Jacksonville, Florida, United States
Background
Renal replacement therapy (RRT) is frequently administered to patients receiving extracorporeal membrane oxygenation (ECMO). RRT helps to manage the fluid and electrolyte imbalances in ECMO-supported patients with or without evidence of advanced kidney failure. The use of RRT on ECMO has been linked to higher fatality rates in both adult and pediatric patients. There are many controversies concerning the timing, type, and temporal relationship of combined RRT and ECMO in patient outcomes. We aimed to analyze the impact on mortalities from the available studies in the use of a combination of these two extracorporeal systems.
Methods
We searched PubMed, EMBASE, and google scholar databases until February 2024 for case–control, cross-sectional, or cohort studies investigating the mortality of RRT on ECMO. We followed PRISMA guidelines to conduct the study. We filtered the study based on title and abstract followed by the full text. Data extraction was done in MS Excel and statistical analysis was done using RevMan v5.4. Relative risk (RR) and 95% confidence intervals (95% CIs) were pooled in the meta-analysis.
Results
We evaluated a total of 22 studies which included a total number of 6,117 patients who were on ECMO support. All the studies were of high quality, ranging from 7 to 9. The presence of RRT was associated with a significant increase in mortality (22 studies, Relative Risk (RR): 1.83, 95% CI: 1.61–2.07, p < 0.001 Figure 1, I2= 64%) when compared to patients on ECMO support alone.
Conclusion
Combination of simulatenous extracorpreal therapies by RRT & ECMO is associated with significantly high patient mortalites. Future studies ought to concentrate on reducing renal dysfunction in individuals on ECMO support, and determining the ideal time for initiation as well as form RRT in these patient population.
Forest plot showing increased risk of mortality in patients receiving combined therapies (ECMO and RRT).