Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort

Coelho, Filipe Utuari de Andrade; Gadioli, Barbara; Freitas, Flavia Fernandes Manfredi de; Vattimo, Maria de Fatima Fernandes

doi:10.1590/1980-220X-REEUSP-2022-0299en

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Original Article • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2022-0299en copy

Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort

Factores asociados a la lesión renal aguda en pacientes sometidos a oxigenación por membrana extracorpórea: cohorte retrospectiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation.

Method:

Retrospective cohort study conducted in an adult Intensive Care Unit with patients undergoing extracorporeal membrane oxygenation from 2012 to 2021. The research used the Kidney Disease Improving Global Outcomes as criteria for definition and classification of acute kidney injury. A multiple logistic regression model was developed to analyze the associated factors.

Results:

The sample was composed of 122 individuals, of these, 98 developed acute kidney injury (80.3%). In multiple regression, the associated factors found were vasopressin use, Nursing Activities Score, and glomerular filtration rate.

Conclusion:

The use of vasopressin, the Nursing Activities Score, and the glomerular filtration rate were considered as factors related to the development of acute kidney injury in patients undergoing extracorporeal membrane oxygenation.

Intensive Care Units; Extracorporeal Membrane Oxygenation; Acute Kidney Injury; Nursing

Variables	Total (n = 122)	No AKI (n = 24)	AKI (n = 98)	p-value
Sex Men	83 (68.0)	14 (58.3)	69 (70.4)	0.256*
Age (years)	55.0 (36.0–62.0)	48.5 (43.5–59.0)	56.0 (36.7–62.2)	0.180**
Comorbidities
SAH	43 (35.2)	7 (29.2)	36 (36.7)	0.487*
CF	28 (23.0)	3 (12.5)	25 (25.5)	0.174*
DM	24 (19.7)	4 (16.7)	20 (20.4)	0.782
COPD	19 (15.6)	4 (16.7)	15 (15.3)	>0.999*
Cancer	12 (9.8)	1 (4.2)	11 (11.2)	0.457*
CRD	7 (5.7)	–	7 (7.1)	0.343***
Stroke	2 (1.6)	–	2 (2.0)	>0.999***
CoVID-19	44 (36.1)	5 (20.8)	39 (39.8)	0.083*
Hospital LOS (days)	31.5 (16.2–59.2)	24.0 (12.2–46.0)	32.5 (17.7–63.0)	0.208**
ICU (days)	21.5 (9.0–41.0)	13.5 (6.2–38.2)	24.0 (10.0–41.7)	0.172**
MV (days)	14.5 (5.0–33.2)	8.5 (4.2–38.2)	15.0 (5.0–33.2)	0.474**
VAD Type
Noradrenaline	121 (99.2)	24 (100.0)	97 (99.0)	>0.999*
Adrenaline	67 (54.9)	11 (45.8)	56 (54.9)	0.318*
Dobutamine	52 (42.6)	10 (41.7)	42 (42.9)	0.916*
Vasopressin	32 (26.2)	2 (8.3)	30 (30.6)	0.026*
Milrinone	18 (14.8)	2 (8.3)	16 (16.3)	0.522*
IAB	26 (21.3)	4 (16.7)	22 (22.4)	0.535*
Weight (Kg)	78.0 (35.0–89.5)	73.0 (66.3–89.9)	78.5 (65.0–87.6)	0.978**
SAPS 3	48.5 (38.0–57.2)	51.0 (39.5–62.7)	47.0 (38.0–57.0)	0.285**
SOFA	9 (7.0–12.0)	8.5 (6.2–10.0)	9.5 (7.0–13.0)	0.178**
VIS	28.5 (9.7–132.5)	28.5 (10.0–143.8)	27.7 (2.5–93.1)	0.308**
NLR	10.2 (6.6–20.1)	11.0 (7.1–21.1)	6.4 (4.4–10.7)	0.001**
NAS	110.7 (99.3–122.0)	96.5 (89.0–99.7)	117.0 (105.3–124.0)	<0.001**
Death	76 (62.3)	12 (50.0)	64 (65.3)	0.166*

Variables	Total (n = 122)	No AKI (n = 24)	AKI (n = 98)	p-value
Indications for ECMO
ARF	68 (55.7)	12 (50.0)	56 (57.1)	0.528*
Cardiogenic shock	29 (23.8)	7 (29.2)	22 (22.4)	0.488*
ECPR	12 (9.8)	3 (12.5)	9 (9.2)	0.702**
Difficulty weaning from ECC	11 (9.0)	2 (8.3)	9 (9.2)	>0.999**
Modality
VA	55 (45.1)	10 (41.7)	45 (45.9)	0.708*
VV	68 (55.7)	14 (58.3)	54 (55.1)	0.775*
Canulation
Peripherical	109 (89.3)	24 (100.0)	85 (86.7)	0.070*
Central	14 (11.5)	–	14 (14.3)	0.070**
Time in ECMO (days)	7.0 (3.0–18.0)	4.5 (2.2-14.5)	8.0 (4.0–18.0)	0.129***
Time elapsed from ICU and start of ECMO (days)	1.5 (0.0–7.2)	0.0 (0.0-3.5)	2.0 (0.0–8.0)	0.042***
RESP	−2.5 (−4.0–0.0)	−2.0 (−3.0–1.0)	−3.0 (−4.0–1.0)	0.119***
SAVE	0.0 (−3.2–2.2)	2.0 (−1.0–4.0)	−1.0 (−4.0–2.0)	0.081***
Decannulation	68 (55.7)	16 (66.7)	52 (53.1)	0.229*

Variables	Total (n = 122)	No AKI (n = 24)	AKI (n = 98)	p-value
SCr at admission (mg/dl)	1.0 (0.8–1.5)	0.9 (0.6–1.1)	1.1 (0.8–1.7)	0.041*
SCr at outcome (mg/dl)	1.1 (0.7–1.9)	0.9 (0.5–1.2)	1.2 (0.8–2.0)	0.025*
GFR at admission (ml/min)	81.5 (48.4–104.6)	96.9 (72.0–120.5)	74.9 (44.7–99.5)	0.022*
GFR at outcome (ml/min)	70.7 (40.0–111.5)	103.4 (56.2–139.7)	63.0 (39.6–99.7)	0.012*
FB (ml)	3230.5 (237.5–6787.5)	861.6 (–2249.1–2778.5)	3320.0 (525.0–7022.5)	0.030*
Fluid Overload	44 (36.1)	3 (12.5)	41 (41.8)	0.007**

	Univariate			Multivariate
	OR	CI 95%	p-value	OR	CI 95%	p-value
Vasopressin	4.85	(1.07–21.96)	0.040	11.41	(1.21-10.86)	0.033
NAS	3.33	(1.38–8.04)	<0.001	1.24	(1.11-1.38)	<0.001
CoVID-19	2.51	(0.86–7.28)	0.090	–	–	–
CF	2.39	(0.65–8.72)	0.185	–	–	–
SOFA	1.08	(0.96–1.21)	0.189	–	–	–
Time elapsed from ICU and start of ECMO (days)	1.08	(0.98–1.19)	0.095	–	–	–
NLR	1.05	(0.99–1.11)	0.087	–	–	–
Time in ECMO (days)	1.01	(0.98–1.04)	0.401	–	–	–
Age	1.01	(0.98–1.04)	0.267	–	–	–
GFR at admission	0.98	(0.94–0.99)	0.023	0.97	(0.95-0.99)	0.014

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Filipe Utuari de Andrade Coelho Av. Dr. Enéas Carvalho de Aguiar, 419, Cerqueira César, 05403-000 – São Paulo, SP, Brazil filipeutuari@gmail.com