National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease

Abstract

Background: Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.

Methods: A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019-2021 Nationwide Readmissions Database. Patients were stratified into non-CKD, CKD 1-2, and CKD 3-5 based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.

Results: Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as CKD 3-5. Following risk adjustment, CKD 3-5 was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10-1.59) and overall complications (AOR 1.72, 95%CI 1.09-2.72) compared to non-CKD. Additionally, both CKD 1-2 and CKD 3-5 were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, CKD 3-5 was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.

Conclusions: Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.

Graphical abstract

Fig. 1

Consolidated Standards of Reporting Trials (CONSORT) diagram demonstrating study design. Patients were grouped into those without CKD (non-CKD), CKD stages 1–2 (CKD 1–2), and CKD stages 3–5 (CKD 3–5). CKD, chronic kidney disease.

Fig. 2

Proportion of venoarterial extracorporeal membrane oxygenation (VA-ECMO) use, stratified by operative indications and severity of chronic kidney disease (CKD). Patients were grouped into without CKD (non-CKD), CKD stages 1–2 (CKD 1–2), and CKD stages 3–5 (CKD 3–5). Thoracic transplantation was defined as heart or lung transplantation performed after undergoing VA-ECMO during the index hospitalization. CP, cardiopulmonary.

Fig. 3

Risk-adjusted probability of (A) in-hospital mortality and (B) overall complications following venoarterial extracorporeal membrane oxygenation (VA-ECMO), stratified by operative indications and the severity of chronic kidney disease (CKD). Patients were grouped into without CKD (non-CKD), CKD stages 1–2 (CKD 1–2), and CKD stages 3–5 (CKD 3–5). Thoracic transplantation was defined as heart or lung transplantation performed after undergoing VA-ECMO during the index hospitalization. CP, cardiopulmonary. *P < 0.05.