1. Synergistic association of fluid overload and acute kidney injury on outcomes in pediatric cardiac ECMO: a retrospective analysis of the KIDMO database
- Author
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Pettit, Kevin A., Selewski, David T., Askenazi, David J., Basu, Rajit K., Bridges, Brian C., Cooper, David S., and Fleming, Geoffrey M.
- Subjects
Blood oxygenation, Extracorporeal -- Patient outcomes ,Acute renal failure -- Care and treatment -- Patient outcomes -- Demographic aspects ,Health - Abstract
Background Acute kidney injury (AKI) and fluid overload (FO) are associated with poor outcomes in children receiving extracorporeal membrane oxygenation (ECMO). Our objective is to evaluate the impact of AKI and FO on pediatric patients receiving ECMO for cardiac pathology. Methods We performed a secondary analysis of the six-center Kidney Interventions During Extracorporeal Membrane Oxygenation (KIDMO) database, including only children who underwent ECMO for cardiac pathology. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. FO was defined as < 10% (FO-) vs. [greater than or equal to] 10% (FO +) and was evaluated at ECMO initiation, peak during ECMO, and ECMO discontinuation. Primary outcomes were mortality and length of stay (LOS). Results Data from 191 patients were included. Non-survivors (56%) were more likely to be FO + than survivors at peak ECMO fluid status and ECMO discontinuation. There was a significant interaction between AKI and FO. In the presence of AKI, the adjusted odds of mortality for FO + was 4.79 times greater than FO- (95% CI: 1.52-15.12, p = 0.01). In the presence of FO +, the adjusted odds of mortality for AKI + was 2.7 times higher than AKI- [95%CI: 1.10-6.60; p = 0.03]. Peak FO + was associated with a 55% adjusted relative increase in LOS [95%CI: 1.07-2.26, p = 0.02]. Conclusions The association of peak FO + with mortality is present only in the presence of AKI + . Similarly, AKI + is associated with mortality only in the presence of peak FO + . FO + was associated with LOS. Studies targeting fluid management have the potential to improve LOS and mortality outcomes. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information., Author(s): Kevin A. Pettit [sup.1] , David T. Selewski [sup.2] , David J. Askenazi [sup.3] , Rajit K. Basu [sup.4] , Brian C. Bridges [sup.5] , David S. Cooper [sup.6] [...]
- Published
- 2023
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