Abstract
Intravascular Hemolysis and AKI in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO): FR-PO109
Journal of the American Society of Nephrology, Vol.33(11S), pp.356-356
11/2022
DOI: 10.1681/ASN.20223311S1356a
Abstract
Background:
AKI is common in ECMO patients. We sought to describe the impact of laboratory evidence of ECMO associated intravascular hemolysis on AKI.
Methods:
This retrospective cohort study included patients treated with ECMO at a single center over ten years. The primary outcome was a composite of time to renal replacement therapy (RRT) or AKI (by creatinine based KDIGO criteria) after ECMO start. Serum creatinine closest to ECMO start time was considered the pre-ECMO baseline and used to determine abnormal kidney function at ECMO start. The patient’s subsequent creatinine values were used to identify AKI on ECMO. Multivariable cause-specific cox proportional hazards models were used to assess the impact of markers of intravascular hemolysis on time to the composite outcome after controlling for confounders.
Results:
501 children were evaluated: median age 1.2 years, 56% male. Four models are presented in Table 1 each with a different marker of hemolysis (plasma free hemoglobin, LDH, minimum platelets and minimum hemoglobin). An elevated plasma free hemoglobin level, the most specific of these hemolysis markers, demonstrated a >3-fold higher hazard for the composite outcome (p-value 0.001). Elevated LDH was associated with an adjusted hazard ratio of 2.4. Effect estimates were more pronounced in a sensitivity analysis of stage 2+ AKI/RRT : HR 6.5 (95% CI 3.3-12.8) for plasma free hemoglobin and 3.3 (95% CI 1.7-6.5) for LDH.
Conclusions:
Laboratory findings consistent with intravascular hemolysis on ECMO were associated with a higher hazard of AKI or RRT in children undergoing ECMO.
Details
- Title: Subtitle
- Intravascular Hemolysis and AKI in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO): FR-PO109
- Creators
- Amy StrongJarcy ZeeRosanna FulchieroDiego CamposTodd J. KilbaughBenjamin L. LaskinMichelle Denburg
- Resource Type
- Abstract
- Publication Details
- Journal of the American Society of Nephrology, Vol.33(11S), pp.356-356
- DOI
- 10.1681/ASN.20223311S1356a
- ISSN
- 1046-6673
- Language
- English
- Date published
- 11/2022
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
- Record Identifier
- 9984775023102771
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