Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Mar;12(2):153-8.
doi: 10.1097/PCC.0b013e3181e2a596.

Recovery of renal function and survival after continuous renal replacement therapy during extracorporeal membrane oxygenation

Matthew L Paden  1 , Barry L Warshaw, Micheal L Heard, James D Fortenberry
Affiliations

Recovery of renal function and survival after continuous renal replacement therapy during extracorporeal membrane oxygenation

Matthew L Paden et al. Pediatr Crit Care Med. 2011 Mar.

Abstract

Objective: To assess the outcome of pediatric patients supported by concomitant extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).

Design, setting, and patients: Acute kidney injury is associated with mortality in ECMO patients. CRRT in patients on ECMO provides an efficient and potentially beneficial method of acute kidney injury management. Concern that concomitant CRRT use increases the risk of developing anuria and chronic renal failure limits its use in some centers. We hypothesized that development of chronic renal failure is rare with concurrent ECMO and CRRT. We evaluated the outcomes of 154 ECMO/CRRT patients cared for over 10 yrs at a referral pediatric medical center.

Interventions: None.

Measurements and main results: Among 68 (44%) ECMO/CRRT survivors, 45 were assigned a pediatric risk, injury, failure, loss and end-stage (referred to as "pRIFLE") score at CRRT initiation. Seventeen (38%) patients met the criteria for Risk, 15 (33%) for Injury, and 10 (22%) for Failure. Two Failure patients later met End stage criteria. Of all survivors, 18 (26%) required ongoing renal replacement therapy (15 required continuous veno-venous hemofiltration, two required peritoneal dialysis, and one patient required intermittent hemodialysis) post ECMO discontinuation. Renal recovery occurred in 65 (96%) of 68 patients before discharge. One neonatal patient had sepsis-induced renal injury on transfer, but had normal creatinine 1 month later. Two pediatric patients with vasculitis and primary renal disease at presentation (both meeting Failure criteria) developed end-stage renal disease. One received peritoneal dialysis and subsequent renal transplant. The other has diminished function without need for renal replacement therapy.

Conclusion: In the absence of primary renal disease, chronic renal failure did not occur after concurrent use of CRRT with ECMO. Concern for precipitating chronic renal failure by using CRRT during ECMO is not substantiated by this large single-center experience. Consistent with previous reports, mortality is higher in patients receiving concomitant CRRT and ECMO compared with those receiving ECMO alone. Mortality is similar to patients requiring CRRT who are not on ECMO. Additional studies are warranted to determine the optimal role of CRRT use in ECMO patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CVVH use at Children's Healthcare of Atlanta at Egleston1997-2007 as percent of ECMO cases
Figure 2
Figure 2
Patients stratified by pRIFLE Criteria
See this image and copyright information in PMC

Comment in

References

    1. Van Meurs K, Lally KP, Peek G, Zwischenberger JB, editors. ECMO – Extracorporeal cardiopulmonary support in critical care. Extracorporeal Life Support Organization. (3rd Edition.) 2005:1–5.
    1. Kolla S, Awad SS, Rich PB, Schreiner RJ, Hirschl RB, Bartlett RH. Extracorporeal life support for 100 adult patients with severe respiratory failure. Ann Surg. 1997;226(4):544–66. - PMC - PubMed
    1. Swaniker F, Kolla S, Moler F, Custer J, Grams R, Bartlett RH, Hirschl RB. Extracorporeal life support outcome for 128 pediatric patients with respiratory failure. J Pediatr Surg. 2000;35(2):197–202. - PubMed
    1. Roy BJ, Cornish JD, Clark RH. Venovenous extracorporeal membrane oxygenation affects renal function. Pediatrics. 1995;95:573–578. - PubMed
    1. Ronco C, Bellomo R, Ricci Z. Continuous renal replacement therapy in critically ill patients. Nephrol Dial Transplant. 2001;16(Suppl 5):67–72. - PubMed

Publication types

LinkOut - more resources