Acute Kidney Injury in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
Panupong Hansrivijit,
Ploypin Lertjitbanjong,
Charat Thongprayoon,
Wisit Cheungpasitporn,
Narothama Reddy Aeddula,
Sohail Abdul Salim,
Api Chewcharat,
Kanramon Watthanasuntorn,
Narat Srivali,
Michael A. Mao,
Patompong Ungprasert,
Karn Wijarnpreecha,
Wisit Kaewput,
Tarun Bathini
Affiliations
Panupong Hansrivijit
Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA
Ploypin Lertjitbanjong
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA
Charat Thongprayoon
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
Wisit Cheungpasitporn
Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
Narothama Reddy Aeddula
Department of Internal Medicine, Deaconess Health System, Evansville, IN 47747, USA
Sohail Abdul Salim
Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
Api Chewcharat
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
Kanramon Watthanasuntorn
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA
Narat Srivali
Division of Pulmonary and Critical Care Medicine, St. Agnes Hospital, Baltimore, MD 21229, USA
Michael A. Mao
Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
Patompong Ungprasert
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44106, USA
Karn Wijarnpreecha
Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
Wisit Kaewput
Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Tarun Bathini
Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
Background: Acute kidney injury (AKI) is a well-established complication of extra-corporal membrane oxygenation (ECMO) in the adult population. The data in the pediatric and neonatal population is still limited. Moreover, the mortality risk of AKI among pediatric patients requiring ECMO remains unclear. Thus, this meta-analysis aims to assess the incidence of AKI, AKI requiring renal replacement therapy and AKI associated mortality in pediatric/neonatal patients requiring ECMO. Methods: A literature search was performed utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring renal replacement therapy (RRT) and the risk of mortality among pediatric patients on ECMO with AKI. Random-effects meta-analysis was used to calculate the pooled incidence of AKI and the odds ratios (OR) for mortality. Results: 13 studies with 3523 pediatric patients on ECMO were identified. Pooled incidence of AKI and AKI requiring RRT were 61.9% (95% confidence interval (CI): 39.0−80.4%) and 40.9% (95%CI: 31.2−51.4%), respectively. A meta-analysis limited to studies with standard AKI definitions showed a pooled estimated AKI incidence of 69.2% (95%CI: 59.7−77.3%). Compared with patients without AKI, those with AKI and AKI requiring RRT while on ECMO were associated with increased hospital mortality ORs of 1.70 (95% CI, 1.38−2.10) and 3.64 (95% CI: 2.02−6.55), respectively. Conclusions: The estimated incidence of AKI and severe AKI requiring RRT in pediatric patients receiving ECMO are high at 61.9% and 40.9%, respectively. AKI among pediatric patients on ECMO is significantly associated with reduced patient survival.
