A multicenter international survey of renal supportive therapy during ECMO: the Kidney Intervention During Extracorporeal Membrane Oxygenation (KIDMO) group

Abstract

Acute kidney injury and fluid overload (FO) are associated with increased mortality in critically ill patients, including the subset supported with extracorporeal membrane oxygenation (ECMO). The indication for and method of application of renal support therapy (RST) during ECMO is largely unknown beyond single-center experiences. The current study uses a survey design to document practice variation regarding RST, including indication, method of interface with the ECMO circuit, and prescribing practices. Sixty-five international ECMO centers (31%) responded to an online electronic survey regarding RST during ECMO. Nearly a quarter of centers (23%) reported using no RST during ECMO. Among those using the therapy, the predominant mode of therapy applied was convection and included slow continuous ultrafiltration and continuous venovenous hemofiltration. The predominant indication for RST was the treatment (43%) or prevention (16%) of FO. Nephrology rather than critical care medicine is reported as the prescribing service in a majority of centers with a significant difference between US centers and non-US centers. The results of this study identify a wide variation in practice regarding RST during ECMO that will offer multiple important avenues for further research by this group and others regarding the interface of RST and ECMO.

Figure 1

Indications for renal support therapy by location. Black bars, US center; white bars, non-US center; FO, fluid overload; AKI, acute kidney injury.

Figure 2

Indications for renal support therapy by predominant indication for ECMO. Black bars, cardiac; white bars, respiratory; gray bars, cardiac + respiratory; FO, fluid overload; AKI, acute kidney injury; ECMO, extracorporeal membrane oxygenation.

Figure 3

Mode of RST by interface with the ECMO circuit. Black bars, in-line hemodiafilter; white bars, RST machine connected to circuit; SCUF, slow continuous ultrafiltration; CVVH, continuous veno-venous hemofiltration; CVVHD, continuous venovenous hemodialysis; CVVHDF, continuous veno-venous hemodiafiltration; ECMO, extracorporeal membrane oxygenation; RST, renal support therapy.