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Review
. 2025 Dec;47(1):2486557.
doi: 10.1080/0886022X.2025.2486557. Epub 2025 Apr 23.

Kidney replacement therapy during extracorporeal membrane oxygenation: pathophysiology, technical considerations, and outcomes

Michele Petrova Xin Ling Lau  1 , Ryan Ruiyang Ling  1   2   3 , Brandon Jin An Ong  1 , Hwa Jin Cho  4   5 , In-Seok Jeong  4   6 , Tapas Kumar Sahoo  7 , Horng Ruey Chua  1   8 , Kiran Shekar  9   10   11   12 , Kollengode Ramanathan  1   13
Affiliations
Review

Kidney replacement therapy during extracorporeal membrane oxygenation: pathophysiology, technical considerations, and outcomes

Michele Petrova Xin Ling Lau et al. Ren Fail. 2025 Dec.

Abstract

The use of extracorporeal membrane oxygenation has been increasing over time, in part due to the COVID-19 pandemic. Whilst lifesaving, complications that must be managed are also associated with its use. AKI and fluid overload are complications of concern due to their associations with poor outcomes, and ability to be managed by additional interventions such as the use of kidney replacement therapy. Various modalities, timings, and types of kidney replacement therapy are currently being used and outcomes regarding its concurrent use with extracorporeal membranous oxygenation across centers may be mixed. In this review, we discuss the pathophysiology of AKI, methods, modalities and impact of concurrent extracorporeal membrane oxygenation and kidney replacement therapy.

Keywords: Extracorporeal membrane oxygenation; acute kidney injury; kidney replacement therapy; pathophysiology.

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Conflict of interest statement

RRL receives research support from the Clinician Scientist Development Unit, Yong Loo Lin School of Medicine, National University of Singapore. KR is part of the Extracorporeal Life Support Organization (ELSO) Steering Committee, and chairs its Publication Committee. He has received honoraria from Xenios for educational lectures on ECMO. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Indications for KRT in ECMO. KRT: kidney replacement therapy, ECMO: extracorporeal membrane oxygenation
Figure 2.
Figure 2.
ECMO and CKRT circuit configurations. KRT: kidney replacement therapy; CKRT: continuous kidney replacement therapy; ECMO: extracorporeal membrane oxygenation
See this image and copyright information in PMC

References

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