WHEN SUPPORT STRAINS: RENAL REPERCUSSIONS OF ECMO; BREATHING ON BORROWED TIME

 

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WHEN SUPPORT STRAINS: RENAL REPERCUSSIONS OF ECMO; BREATHING ON BORROWED TIME

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Dr Sayonee
Das
Dr Sayonee Das dr.sayoneedas@gmail.com Apollo Multispeciality Hospital Nephrology Kolkata India *
Dr Jayasurya R drsuryatvm@gmail.com Apollo Multispeciality Hospital Nephrology Kolkata India -
Dr Divya Jyoti Divyajyoti2421@gmail.com Apollo Multispeciality Hospital Nephrology Kolkata India -
Dr Arpan Chakraborty drarpanecmo@gmail.com Apollo Multispeciality Hospital Critical care medicine Kolkata India -
Dr Pradipta Bhattacharya pradipta_pilot@yahoo.com Apollo Multispeciality Hospital Critical care medicine Kolkata India -
Dr Manish Jain manish_dr_jain@yahoo.in Apollo Multispeciality Hospital Nephrology Kolkata India -
Dr Sandip Bhattacharya skb_Ipprayas@hotmail.com Apollo Multispeciality Hospital Nephrology Kolkata India -
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Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention for potentially reversible severe cardiac or respiratory failure. Acute kidney injury (AKI) is a common complication in this setting, often necessitating renal replacement therapy (RRT) and worsening outcomes. This study aims to assess the incidence, risk factors, and outcomes of AKI in patients receiving ECMO.

This single-centre, prospective study, conducted from 2023 to 2025, included 45 patients who underwent ECMO for more than 24 hours. Patients with end-stage renal disease (ESRD) on maintenance hemodialysis were excluded. Acute kidney injury was diagnosed and categorised according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Of the 45 patients studied, 12 patients (26.66%) developed AKI, and 9 patients (75%) among them developed AKI within 24 hours of initiation of ECMO. Sepsis, inotropic support and poor cardiac function were the risk factors associated with the development of AKI. RRT was required in all 12 patients (100%), although out of the 3 (25%) recipients who survived, none had RRT dependence. Severe AKI requiring Continuous Renal Replacement Therapy (CRRT) occurred in 4 (33%) of ECMO patients. The overall mortality in the whole group was 62.22%(28/45), rising to 75% (9/12) among the patients with AKI.

AKI during ECMO support markedly increases mortality risk. Preventive strategies, early detection, and appropriate,timely management of AKI are essential to improving survival outcomes in ECMO patients.

Kewords