A two-centre study in Thailand has found that patients who develop acute kidney injury before receiving VA-ECMO have higher unadjusted ICU mortality, although the association weakens after accounting for illness severity.
The timing of acute kidney injury (AKI) may provide important information when doctors assess the risks and outcomes of patients receiving vend-arterial extracorporeal membrane oxygenation (VA-ECMO), according to a new study published in Thailand.
Researchers analysed medical data from 172 adults treated with VA-ECMO at two centres in Thailand. The study aimed to understand whether developing kidney injury before or after starting ECMO could influence patients’ chances of survival.
The patients were divided into three groups: those who developed AKI before ECMO, those who developed it after treatment began, and those who did not develop AKI. Among the participants, 81 (47.1%) developed AKI before ECMO, while 82 (47.7%) developed it afterwards. Only nine patients (5.2%) had no AKI.
The findings showed that patients with kidney injury before ECMO had more severe kidney problems and were more likely to require renal replacement therapy. They also experienced acute liver injury more frequently.
ICU mortality was higher in the pre-ECMO AKI group, at 82.7%, compared with 69.5% among patients who developed AKI after ECMO started.
However, after researchers adjusted the results for factors such as age, sex, existing kidney disease and illness severity, the association was no longer statistically significant. This suggests that the higher mortality may be linked to the patients’ overall critical condition rather than kidney injury timing alone.
The researchers highlighted that AKI before ECMO may indicate severe shock and damage to multiple organs before treatment begins.
The findings suggest that doctors should consider kidney function alongside other signs of organ damage and overall illness severity when assessing patients for VA-ECMO.
Importantly, the researchers concluded that early AKI should be considered during treatment planning and risk assessment, but should not automatically prevent patients from receiving ECMO support. Further studies are needed to confirm its independent impact on survival.
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