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Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021
Journal article   Peer reviewed

Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021

Amy E Strong, Spandana Makeneni, Diego Campos, Rosanna Fulchiero, Todd J Kilbaugh, James Connelly, Benjamin L Laskin, Jarcy Zee and Michelle R Denburg
Pediatric critical care medicine, Vol.26(3), pp.e287-e293
03/2025
DOI: 10.1097/PCC.0000000000003650
PMCID: PMC11885026
PMID: 39660975

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Abstract

Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease. Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m2, which subsequently improved to normal (≥ 90 mL/min/1.73 m2); 2) abnormal eGFR of less than 90 mL/min/1.73 m2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR. Single-center tertiary care children's hospital system. All pediatric patients surviving ECMO from 2009 to 2019. None. In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3-8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1-6 episodes). This 2009-2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.
 acute kidney injury chronic kidney disease extracorporeal membrane oxygenation long-term outcomes

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