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; Michelle R Denburg

doi:10.1097/PCC.0000000000003650

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

Pediatr Crit Care Med. 2024 Dec 11. doi: 10.1097/PCC.0000000000003650. Online ahead of print.

Authors

Amy E Strong^{1

2}, Spandana Makeneni³, Diego Campos⁴, Rosanna Fulchiero^{1

5}, Todd J Kilbaugh^{6

7}, James Connelly⁷, Benjamin L Laskin^{1

8}, Jarcy Zee^{3

9}, Michelle R Denburg^{1

8

9}

Affiliations

¹ Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA.
² Department of Pediatrics, Division of Nephrology, University of Iowa Carver College of Medicine, Iowa City, IA.
³ Children's Hospital of Philadelphia Research Institute, Philadelphia, PA.
⁴ Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA.
⁵ Division of Nephrology, Inova L.J. Murphy Children's Hospital, Falls Church, VA.
⁶ Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
⁷ ECMO Center at Children's Hospital of Philadelphia, Philadelphia, PA.
⁸ Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
⁹ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

PMID: 39660975
DOI: 10.1097/PCC.0000000000003650

Abstract

Objectives: 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.

Design: 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.

Setting: Single-center tertiary care children's hospital system.

Patients: All pediatric patients surviving ECMO from 2009 to 2019.

Interventions: None.

Measurements and main results: 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).

Conclusions: 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.