Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

• Published in: Journal of clinical medicine Vol. 10; no. 2; p. 241
• Main Authors: Mitra, Saikat, Ling, Ryan Ruiyang, Tan, Chuen Seng, Shekar, Kiran, MacLaren, Graeme, Ramanathan, Kollengode
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 11.01.2021; MDPI
• Subjects: Clinical medicine; Clinical outcomes; Confidence intervals; Creatinine; Extracorporeal membrane oxygenation; Hemodialysis; Males; Meta-analysis; Mortality; Patients; Pediatrics; Renal replacement therapy; Review; Systematic review; mortality; renal replacement therapy; acute kidney injury; extracorporeal membrane oxygenation
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10020241

Patients supported with extracorporeal membrane oxygenation (ECMO) often receive renal replacement therapy (RRT). We conducted this systematic review and meta-analysis (between January 2000 and September 2020) to assess outcomes in patients who received RRT on ECMO. Random-effects meta-analyses were performed using R 3.6.1 and certainty of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was pooled mortality. The duration of ECMO support and ICU/hospital lengths of stay were also investigated. Meta-regression analyses identified factors associated with mortality. A total of 5896 adult patients (from 24 observational studies and 1 randomised controlled trial) were included in this review. Overall pooled mortality due to concurrent use of RRT while on ECMO from observational studies was 63.0% (95% CI: 56.0–69.6%). In patients receiving RRT, mortality decreased by 20% in the last five years; the mean duration of ECMO support and ICU and hospital lengths of stay were 9.33 days (95% CI: 7.74–10.92), 15.76 days (95% CI: 12.83–18.69) and 28.47 days (95% CI: 22.13–34.81), respectively, with an 81% increased risk of death (RR: 1.81, 95% CI: 1.56–2.08, p < 0.001). RRT on ECMO was associated with higher mortality rates and a longer ICU/hospital stay compared to those without RRT. Future research should focus on minimizing renal dysfunction in ECMO patients and define the optimal timing of RRT initiation.