Experience of Use of Renal Replacement Therapy in Patients During Extracorporeal Membrane Oxygenation

Abstract

The aim. To provide retrospective single-center analysis of the influence of acute renal injury (ARI) on mortality in pa-tients on extracorporeal membrane oxygenation (ECMO). Materials and methods. On the basis of the Ukrainian Children’s Cardiac Center in the period from 2014 to 2018, 11 procedures of ECMO were conducted. ECMO was started in 7 (64 %) patients due to the development of acute heart failure; in 2 (18 %) patients due to pneumonia and the development of acute respiratory distress syndrome; in 1 (9 %) patient it was carried out due to sepsis and in 1 child (9%) due to arrhythmia. We used two methods to treat ARI in our patients: peri-toneal dialysis and modified ultrafiltration. Diavitec PD 4.25 % solution (Yuria-Pfarm) was used for dialysis, and Medos® and Terumo® hemoconcentrators were used for ultrafiltration. Results and discussion. The number of successful ECMO procedures was 7 (63.5 %) out of 11. ECMO procedure was considered successful if, after decanulation, the patient lived for 48 hours. Of the 7 successfully decanulated patients, 3 (43 %) were discharged from the hospital. Of the 11 patients, in 1 child (9 %), the kidney function was maintained, and 10 (91 %) patients developed acute kidney damage AKIN3. Due to the acute kidney damage, six (55 %) children underwent ultrafiltration as a replacement therapy; 1 (9 %) child had peritoneal dialysis; in 3 (27 %) patients no therapy was conducted. After the start of ECMO, we significantly improved blood flow. Due to the effective perfusion of tissues, normalization of serum lactate level on the day 2 after ECMO, diuresis resumed on the day 3 or 4, the level of creatinine decreased on the day 8 or 9. All the patients receiving renal replacement therapy (RRT) showed positive changes in terms of the treatment of ARI but had fatal outcome for other reasons. The total mortality was 73 %. Conclusion. ECMO is a procedure that allows for the oxygen delivery in critical patients when other methods of intensive care are ineffective. AKI developed in 90 % of patients on ECMO and required replacement therapy, including ultrafiltra-tion. Acute kidney damage requiring replacement therapy is a predictor of the disease deterioration and increased mortality in children with congenital heart disease undergoing surgical intervention using a cardiopulmonary bypass. Ultrafiltration was not associated with the development of complications and allowed to achieve negative fluid balance.

Keywords

• acute kidney injury
• ultrafiltration
• peritoneal dialysis
• extracorporeal membrane therapy
• congenital heart disease