Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

Heidi J. Murphy*, Jason Gien, Rashmi Sahay, Eileen King, David T. Selewski, Brian C. Bridges, David S. Cooper, Geoffrey M. Fleming, Matthew L. Paden, Michael Zappitelli, Katja M. Gist, Rajit K. Basu, Jennifer G. Jetton, David Askenazi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Introduction: We aimed to characterize acute kidney injury (AKI), fluid overload (FO), and renal replacement therapy (RRT) utilization by diagnostic categories and examine associations between these complications and mortality by category. Methods: To test our hypotheses, we conducted a retrospective multicenter, cohort study including 446 neonates (categories: 209 with cardiac disease, 114 with congenital diaphragmatic hernia [CDH], 123 with respiratory disease) requiring extracorporeal membrane oxygenation (ECMO) between January 1, 2007, and December 31, 2011. Results: AKI, FO, and RRT each varied by diagnostic category. AKI and RRT receipt were most common in those neonates with cardiac disease. Subjects with CDH had highest peak %FO (51% vs. 28% cardiac vs. 32% respiratory; p < 0.01). Hospital survival was 55% and varied by diagnostic category (45% cardiac vs. 48% CDH vs. 79% respiratory; p < 0.001). A significant interaction suggested risk of mortality differed by diagnostic category in the presence or absence of AKI. In its absence, diagnosis of CDH (vs. respiratory disease) (OR 3.04, 95% CL 1.14-8.11) independently predicted mortality. In all categories, peak %FO (OR 1.20, 95% CL 1.11-1.30) and RRT receipt (OR 2.12, 95% CL 1.20-3.73) were independently associated with mortality. Discussion/Conclusions: Physiologically distinct ECMO diagnoses warrant individualized treatment strategies given variable incidence and effects of AKI, FO, and RRT by category on mortality.

Original languageEnglish (US)
Pages (from-to)808-817
Number of pages10
JournalBlood Purification
Volume50
Issue number6
DOIs
StatePublished - Sep 1 2021
Externally publishedYes

Keywords

  • Continuous renal replacement therapy
  • Extracorporeal membrane oxygenation
  • Extracorporeal therapy
  • Renal dysfunction
  • Renal failure
  • Renal injury

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Fingerprint

Dive into the research topics of 'Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately'. Together they form a unique fingerprint.

Cite this