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. 2025 Mar 1;26(3):e287-e293.
doi: 10.1097/PCC.0000000000003650. Epub 2024 Dec 11.

Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021

Amy E Strong  1   2 , Spandana Makeneni  3 , Diego Campos  4 , Rosanna Fulchiero  1   5 , Todd J Kilbaugh  6   7 , James Connelly  7 , Benjamin L Laskin  1   8 , Jarcy Zee  3   9 , Michelle R Denburg  1   8   9
Affiliations

Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021

Amy E Strong et al. Pediatr Crit Care Med. .

Abstract

Objectives: Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease.

Design: Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m 2 ) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m 2 , which subsequently improved to normal (≥ 90 mL/min/1.73 m 2 ); 2) abnormal eGFR of less than 90 mL/min/1.73 m 2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m 2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR.

Setting: Single-center tertiary care children's hospital system.

Patients: All pediatric patients surviving ECMO from 2009 to 2019.

Interventions: None.

Measurements and main results: In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3-8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1-6 episodes).

Conclusions: This 2009-2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.

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Conflict of interest statement

Drs. Strong’s and Denburg’s institutions received funding from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Strong’s institution received funding from the Carole Marcus Mid-Career Award to Promote Career Development and Mentoring in Pediatric Research. Drs. Strong, Fulchiero, and Denburg received support for article research from the National Institutes of Health (NIH). Dr. Campos disclosed work for hire. Dr. Kilbaugh received support for article research from the National Institute of Neurological Disorders and Stroke and the National Heart, Lung, and Blood Institute. Dr. Zee’s institution received funding from received funding from the NIH, NephCure, and OptumLabs; she received funding from Booz Allen Hamilton. Dr. Denburg’s institution received funding from Mallinckrodt Pharmaceuticals (not related to this work) ending in December 2021; she received funding from the American Society of Nephrology and Kidney Disease: Improving Global Outcomes; and she disclosed her spouse received funding from AstraZeneca, TriSalus Life Sciences, In-Bore, and Precision Guided Interventions. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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