Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis.
Saikat MitraRyan Ruiyang LingChuen Seng TanKiran ShekarGraeme MacLarenKollengode RamanathanPublished in: Journal of clinical medicine (2021)
Patients supported with extracorporeal membrane oxygenation (ECMO) often receive renal replacement therapy (RRT). We conducted this systematic review and meta-analysis (between January 2000 and September 2020) to assess outcomes in patients who received RRT on ECMO. Random-effects meta-analyses were performed using R 3.6.1 and certainty of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was pooled mortality. The duration of ECMO support and ICU/hospital lengths of stay were also investigated. Meta-regression analyses identified factors associated with mortality. A total of 5896 adult patients (from 24 observational studies and 1 randomised controlled trial) were included in this review. Overall pooled mortality due to concurrent use of RRT while on ECMO from observational studies was 63.0% (95% CI: 56.0-69.6%). In patients receiving RRT, mortality decreased by 20% in the last five years; the mean duration of ECMO support and ICU and hospital lengths of stay were 9.33 days (95% CI: 7.74-10.92), 15.76 days (95% CI: 12.83-18.69) and 28.47 days (95% CI: 22.13-34.81), respectively, with an 81% increased risk of death (RR: 1.81, 95% CI: 1.56-2.08, p < 0.001). RRT on ECMO was associated with higher mortality rates and a longer ICU/hospital stay compared to those without RRT. Future research should focus on minimizing renal dysfunction in ECMO patients and define the optimal timing of RRT initiation.
Keyphrases
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- respiratory failure
- mechanical ventilation
- end stage renal disease
- cardiovascular events
- ejection fraction
- newly diagnosed
- intensive care unit
- chronic kidney disease
- risk factors
- healthcare
- systematic review
- acute kidney injury
- randomized controlled trial
- coronary artery disease
- clinical trial
- peritoneal dialysis
- adverse drug
- adipose tissue
- cardiovascular disease
- patient reported outcomes
- acute care
- type diabetes
- current status
- locally advanced
- weight loss