Journal article
Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation
Intensive care medicine. Paediatric and neonatal, Vol.2(1), 28
09/13/2024
DOI: 10.1007/s44253-024-00051-4
Abstract
Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used primarily for reversible cardiopulmonary failure across the lifespan. Mortality from multiple organ failure on ECMO is high, and unfortunately, complications such as acute kidney injury (AKI) and disorders of fluid balance such as fluid overload (FO) necessitating continuous renal replacement therapy (CRRT) are also common. The largest series of AKI, FO and ECMO related outcomes has been published by the Kidney Interventions During Membrane Oxygenation (KIDMO) multicenter study, which demonstrated patients with AKI and FO have worse outcomes, corroborating with findings from previous single center studies. There are multiple ways to perform CRRT during ECMO, but integration of a CRRT machine in series is the most common approach in neonates and children. The optimal timing of when to initiate CRRT, and how fast to remove fluid during ECMO remain unknown, and there is an urgent need to design studies with these research questions in mind. The disposition and clearance of drugs on ECMO also require urgent study, as drugs metabolism not only is disproportionately affected by the presence of AKI and FO, but also by CRRT prescription and the rate of fluid removal. In this review, we discuss the contemporary epidemiology and outcomes of AKI and FO during ECMO, as well as the use of concurrent CRRT and highlight evidence gaps as a research map.
Details
- Title: Subtitle
- Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation
- Creators
- Katja M Gist - University of CincinnatiPatricia Bastero - Baylor College of MedicineZaccaria Ricci - Meyer Children's HospitalAhmad Kaddourah - Sidra Medical and Research CenterAmy Strong - University of IowaRahul Chanchlani - McMaster UniversityHeidi J. Steflik - Medical University of South CarolinaAyse Akcan Arikan - Baylor College of MedicineDana Y Fuhrman - University of Pittsburgh School of MedicineBen Gelbart - University of MelbourneShina Menon - Stanford University School of MedicineTara Beck - University of Pittsburgh School of MedicineBrian Bridges - Medical University of South CarolinaSarah N. Fernandez Lafever - Universidad Complutense de MadridClaus Peter Schmitt - Heidelberg UniversityStephen M Gorga - University of Michigan Medical SchoolAsma Salloo - University of Cape TownRajit K Basu - Lurie Children's HospitalMatthew Paden - Emory UniversityDavid T Selewski - Medical University of South Carolina
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine. Paediatric and neonatal, Vol.2(1), 28
- Publisher
- Springer International Publishing
- DOI
- 10.1007/s44253-024-00051-4
- ISSN
- 2731-944X
- eISSN
- 2731-944X
- Language
- English
- Date published
- 09/13/2024
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
- Record Identifier
- 9984775274502771
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