3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset

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Purpose:Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome.Methods:Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included.Results:AKI occurrence was frequent (75%; n = 45), 51% of patients (n = 31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n = 26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p < 0.001) and a higher 90-day mortality rate (72% vs 32%, p = 0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2 > 57 mm Hg and mSOFA > 12 were independent risks factors for 90-day mortality.Conclusion:KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival.HighlightsAcute kidney injury (AKI) occurrence is frequent under veno-venous ECMO supportSevere AKI defined as KDIGO stage 3, concerns 1 in 2 patients and occurs early during patients' managementSevere AKI is associated with higher mortality and a lower mechanical ventilation weaning ratePrior KDIGO stage 3, paCO2 > 57 mmHg and mSOFA > 12 at ECMO initiation were independent risks factors for 90-days mortality

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