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. 2025 May 10:26:87-93.
doi: 10.1016/j.sopen.2025.04.011. eCollection 2025 Jun.

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

Oh Jin Kwon  1   2 , Esteban Aguayo  1   2 , Kevin Tabibian  1   2 , Jeffrey Balian  1   2 , Arjun Chaturvedi  1   2 , Dariush Yalzadeh  1   2 , Joseph Hadaya  1   2   3 , Yas Sanaiha  1   2   3   4 , Peyman Benharash  1   2   3   4
Affiliations

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

Oh Jin Kwon et al. Surg Open Sci. .

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.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Unlabelled Image
Graphical abstract
Fig. 1
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
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
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.
See this image and copyright information in PMC

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