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. 2019 Jul 5;8(7):981.
doi: 10.3390/jcm8070981.

Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Charat Thongprayoon  1 , Wisit Cheungpasitporn  2 , Ploypin Lertjitbanjong  3 , Narothama Reddy Aeddula  4 , Tarun Bathini  5 , Kanramon Watthanasuntorn  3 , Narat Srivali  6 , Michael A Mao  7 , Kianoush Kashani  8   9
Affiliations

Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Charat Thongprayoon et al. J Clin Med. .

Abstract

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO.

Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527).

Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%-72.4%) and 44.9% (95%CI: 40.8%-49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87-4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21-4.99). There was no publication bias as evaluated by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively.

Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

Keywords: AKI; ECMO; acute kidney injury; epidemiology; extracorporeal membrane oxygenation; meta-analysis.

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Conflict of interest statement

The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
The flowchart for the systematic review.
Figure 2
Figure 2
Forest plots of the included studies assessing (A) incidence rates of AKI while on ECMO and (B) incidence rate of severe AKI requiring RRT while on ECMO. A diamond data marker depicts the overall rate from each included study (square data marker) and 95%CI.
Figure 3
Figure 3
Meta-regression analyses showed that year of the study did not significantly affect (A) the incidence of AKI (p = 0.67) or (B) AKI requiring RRT (p = 0.83). The solid black line depicts the weighted regression line based on variance-weighted least squares. The inner and outer lines represent the 95%CI and prediction interval encompassing the regression line. The circles indicate log event rates in individual study.
Figure 4
Figure 4
Forest plots of the included studies assessing (A) mortality rate of patients with AKI while on ECMO and (B) mortality rate of patients with severe AKI requiring RRT while on ECMO. A diamond data label serves as the overall rate from each study (square data marker) and 95%CI.
Figure 5
Figure 5
Forest plots of the included studies assessing (A) hospital mortality among patients receiving ECMO with AKI on RRT and (B) hospital mortality among patients receiving ECMO with AKI on RRT limited to studies with confounder-adjusted analysis. A diamond data label serves as the overall rate from each included study (square data marker) and 95%CI.
Figure 6
Figure 6
Meta-regression analyses showed that year of the study did not significantly affect hospital mortality among patients receiving ECMO with AKI requiring RRT (p = 0.86). The solid black line depicts the weighted regression line based on variance-weighted least squares. The inner and outer lines represent the 95%CI and prediction interval encompassing the regression line. The circles indicate log event rates in an individual study.
Figure 7
Figure 7
Funnel plot demonstrated no publication bias in analyses evaluating (A) incidence of AKI in patients requiring ECMO and (B) severe AKI requiring RRT.
See this image and copyright information in PMC

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